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Guidelines for sites linking to mayoclinic.orgBrain tumor treatment at Mayo Clinic is a team process. A patient may see several Mayo Clinic specialists from the brain tumor treatment team, who work together to provide the high-quality, integrated care for which Mayo Clinic is known. Generally, a neurologist who has expertise and additional training in neuro-oncology, will coordinate the care team. In addition, the neuro-oncologist will counsel the patient about neurologic issues.
Because new treatments develop continually, several options may be available for patients at different points in their treatment. The pros and cons of each option are discussed in detail during treatment planning. Mayo Clinic's goal is to improve the duration and quality of survival. Every effort is made to tailor the treatment program to the needs of the patient and family.
When appropriate, the patient's case history may be presented and discussed with a multidisciplinary tumor team, comprised of specialists in neurosurgery, medical oncology, neurology, radiation oncology, neuroradiology and neuropathology. This collaborative team helps identify the best treatment plan.
Most brain tumor care, aside from surgery, is delivered on an outpatient basis.
During chemotherapy and radiation therapy, blood counts and blood chemistry are closely monitored. During phases of active therapy (which can last up to a year or more) MRI scans of the brain are obtained at regular intervals to monitor tumor growth or shrinkage. These scans are also conducted for several years after active therapy has been completed to watch for signs of tumor recurrence and allow for immediate intervention, if necessary.
Quality of life is as important as quantity of life in Mayo's treatment plans. As cancer treatments become more successful, enabling patients to live longer, patients face greater risks of long-term adverse effects of treatment. The most significant adverse effects are cognitive problems. Mayo specialists, including world-renowned neuropsychologists and experts in brain rehabilitation, help patients with these issues. Almost all clinical trials at Mayo and the North Central Cancer Treatment Group incorporate quality of life measures.
Whenever possible, the brain tumor treatment team tries to integrate care from the patient's local physician and oncologists to offer the most comprehensive management. Mayo specialists work with local physicians to administer some therapy closer to home for patients who live a significant distance from Mayo Clinic.
Sophisticated 3-D computer models help Mayo neurosurgeons plan the safest way to a brain tumor.
Surgery is the initial therapy for nearly all patients with brain tumors and can cure most benign tumors, including meningiomas. The goal of surgery is to remove as much of the tumor as possible while minimizing damage to healthy tissue.
Some tumors can be removed completely; others can be removed only partially or not at all. Partial removal helps relieve symptoms by reducing pressure on the brain and reducing the size of the tumor to be treated by radiation or chemotherapy.
After the tumor has been removed, Mayo Clinic pathologists immediately evaluate the tissue and report results directly to the surgeon in the operating room. Direct, face-to-face contact with the pathologist during the surgery allows the surgeon to verify that the tumor has been fully removed and may reduce the need for an additional operation.
If a tumor cannot be surgically removed, the physician may do only a biopsy. A small piece of the tumor is removed so a pathologist can examine it under a microscope to determine its cell makeup. The finding helps determine the proper treatment.
Patients diagnosed with brain tumors often can be scheduled for surgery the next day, if desired. Surgeons provide patients with information to help them decide which treatment is best for them.
Surgical removal demands great skill. Mayo's neurosurgeons operate on hundreds of patients each year, using the latest technological advances. Mayo surgeons were pioneers in developing computer-assisted neurosurgery, which allows surgeons to precisely map the brain and more accurately and aggressively treat brain tumors.
Another technology available at Mayo is intraoperative MRI, which provides the neurosurgeon with real-time data on tumor volume and location.
Mayo Clinic neurosurgeons also use awake brain surgery on tumors that infiltrate brain regions which control functions like speech and movement. The surgery is performed with the patient awake during segments of the operation. The patient's responses to questions allow the surgeon and attending team to more precisely identify critical brain regions and minimize injury during tumor removal.
Lasers are sometimes used to remove tumors. In some cases, tumors can be removed using minimally invasive techniques. Innovative techniques such as gene therapy also are available under research protocols.
Radiotherapy is an essential component of treatment for many patients with brain tumors. It can cure some patients and prolongs survival for most. Radiation is often the primary treatment for patients with metastatic brain tumors.
This traditional form of radiation therapy delivers radiation from outside the body. The radiation usually involves treatments five days a week; the length of time depends on the type of tumor. External beam radiation is less precise, but allows a wider area of tissue around the tumor to be treated.
This technique minimizes damage to normal tissue by carefully targeting radiation. The treatment involves many smaller treatments rather than one big "shot" of radiation. Normal brain tissues and cranial nerves can tolerate many smaller treatments but cannot tolerate single large treatments. FSR also offers the biological benefit of fractionation, which is to exploit the different sensitivities of normal versus cancer tissue. These advantages are helpful when treating lesions near structures such as the optic nerves, which cannot tolerate high levels of radiation.
For this procedure, the patient is fitted with a plastic mask that aids in targeting the radiation and locating the tumor during treatment. The patient lies on a table and X-rays are taken to determine correct positioning. The treatment is given in several smaller units called arcs. The number of treatments depends on the size and location of the tumor.
Gamma Knife Machine™
Stereotactic radiosurgery is effective for well-circumscribed lesions such as meningioma or limited brain metastases. Radiosurgery precisely targets the tumor with high doses of radiation, while sparing nearby normal tissue because there is a rapid fall-off of radiation at the edges of the area being treated.
Although chemotherapy provides only modest benefit for many patients with brain tumors, it plays an increasingly important role in pain relief. Chemotherapy benefits only a small number of patients with glioma over the long term.
Corticosteroids are indispensable for controlling increased intracranial pressure and reducing tumor sizes. Unfortunately, the long-term use of these agents can result in substantial toxic effects. Anti-convulsant drugs are sometimes administered after surgery in patients who have had seizures.
Deep vein thrombosis or pulmonary emboli can occur in 20 percent to 30 percent of patients with primary brain tumors. Conventional therapy with heparin and warfarin is usually effective and well tolerated.
Mayo Clinic participates in numerous clinical trials for brain and nervous system tumors, including trials originating at Mayo Clinic and those sponsored by the National Cancer Institute through the North Central Cancer Treatment Group (NCCTG).
Brain injury can lead to problems with thoughts, feelings and behaviors. Many people with brain injury find that returning to independent living, work or school presents challenges that they cannot cope with alone. Mayo Clinic rehabilitation specialists help people with brain injury live as independently as possible within their family and community.
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