Treatment

Teamwork and collaboration are the hallmarks of care at Mayo Clinic. Upon considering the results of the evaluation and tests conducted, your Mayo Clinic physicians will work with you to determine the best treatment option(s) for you and your lifestyle.

Treatment for a brain tumor depends on the type, size and location of the tumor, as well as your overall health and preferences. Your treatment plan will be tailored to fit your particular situation, providing exactly the care you need.

Surgery

If a brain tumor is located in a place that makes it accessible for an operation, your neurosurgeon will remove as much of the brain tumor as possible. At Mayo Clinic, experienced neurosurgeons perform over 1,000 of these operations each year to remove tumors while minimizing damage to healthy tissue.

Neurosurgery Neurosurgery at Mayo Clinic

In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumors can't be separated from surrounding tissue or they're located near sensitive areas in your brain, making surgery risky. In these situations your doctor may try to remove as much of the tumor as is safe. Mayo Clinic's expertise in computer-assisted brain surgery allows neurosurgeons to precisely locate tumors and remove them using the safest and least invasive route possible. Since the brain can shift during surgery, brain-mapping techniques and intraoperative MRI create accurate pictures of the brain that guide the neurosurgeon in effectively removing only the tumor and avoiding any functional brain tissue, to preserve hearing, language and other important brain functions.

Even removing a portion of the brain tumor may help reduce your signs and symptoms. In some cases, only a small biopsy is taken to confirm the diagnosis.

Surgery to remove a brain tumor carries risks, such as infection and bleeding. Other risks may depend on the part of your brain where your tumor is located. For instance, surgery on a tumor near nerves that connect to your eyes may carry a risk of vision loss. At Mayo Clinic, the neurosurgery team is very attentive to quality of life and will help patients weigh the benefits of surgery against potential surgically induced deficits.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, radiation can be placed inside your body close to your brain tumor (brachytherapy).

External beam radiation can focus just on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole-brain radiation). Whole-brain radiation is most often used to treat cancer that has spread to the brain from some other part of the body.

Side effects of radiation therapy depend on the type and dose of radiation you receive. In general, it can cause fatigue, headaches and scalp irritation.

Mayo Clinic is launching a Proton Beam Therapy Program, opening in summer 2015 in Minnesota and 2016 in Arizona. Unlike most others in the United States, Mayo Clinic's proton beam will feature intensity-modulated proton beam therapy exclusively. This represents an advance over traditional radiotherapy because the radiation beam is targeted only to the tumor, better sparing surrounding healthy tissue from harm.

Radiosurgery

Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn't particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.

Radiosurgery is typically done in one treatment, and in most cases you can go home the same day.

Chemotherapy

Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously). The chemotherapy drug used most often to treat brain tumors is temozolomide (Temodar), which is taken as a pill. Many other chemotherapy drugs are available and may be used depending on the type of cancer.

Chemotherapy side effects depend on the type and dose of drugs you receive. Chemotherapy can cause nausea, vomiting and hair loss.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.

One targeted drug therapy used to treat a type of brain cancer called glioblastoma is bevacizumab (Avastin). This drug, given through a vein (intravenously), stops the formation of new blood vessels, cutting off blood supply to a tumor and killing the tumor cells.

The targeted drug everolimus (Afinitor) is used to treat a benign brain tumor that occurs in people with a genetic disorder called tuberous sclerosis. Everolimus blocks an enzyme in the body that plays a role in growth of cancer cells.

Clinical trials

At Mayo Clinic, we are always working to develop new treatments to improve outcomes for patients with brain tumors. Experimental treatments that may be available include new imaging techniques to guide surgery and radiation, new chemotherapy or targeted drug treatments, and even viruses that kill tumor cells, and vaccines or other medications that stimulate the immune system to kill tumor cells.

Rehabilitation after treatment

Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Your doctor may refer you to services that can help, such as:

  • Physical therapy can help you regain lost motor skills or muscle strength.
  • Occupational therapy can help you get back to your normal daily activities, including work, after a brain tumor or other illness.
  • Speech therapy with specialists in speech difficulties (speech pathologists) can help if you have difficulty speaking.
  • Tutoring for school-age children can help kids cope with changes in their memory and thinking after a brain tumor.

Potential future treatments

In the neuro-oncology research laboratories, Mayo Clinic scientists are testing new ways to target and kill cancer cells, disrupt tumor growth, and develop novel combination strategies to augment traditional treatment approaches. The Mayo Clinic Cancer Center is one of only four U.S. cancer centers to receive a National Cancer Institute-sponsored Specialized Program of Research Excellence (SPORE) grant for brain cancer research. Researchers in the Mayo Clinic Brain Cancer SPORE study the mechanisms that can lead to the development of brain cancer and develop interventions to improve the length and quality of life for patients with brain tumors.

Living with Brain Tumors

Nov. 22, 2014
References
  1. What you need to know about brain tumors. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/brain. Accessed Oct. 4, 2013.
  2. Adult brain tumors treatment (PDQ): Health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/healthprofessional. Accessed Oct. 4, 2013.
  3. Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Oct. 4, 2013.
  4. Childhood brain and spinal cord tumors treatment overview (PDQ): Health professional version. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/childbrain/healthprofessional. Accessed Oct. 4, 2013.
  5. Niederhuber JE, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed Oct. 4, 2013.
  6. Armstrong TS, et al. Use of complementary and alternative medical therapy by patients with primary brain tumors. Current Neurology and Neuroscience Reports. 2008;8:264.
  7. Avastin (prescribing information). South San Francisco, Calif.: Genentech Inc.; 2013. http://www.avastin.com/patient/index.html. Accessed Oct. 4, 2013.
  8. Afinitor (prescribing information). East Hanover, N.J.: Novartis Pharmaceuticals Corp.; 2014. http://www.afinitor.com. Accessed Oct. 4, 2013.
  9. Temodar (prescribing information). Whitehouse Station, N.J.: Merck & Co. Inc.; 2013. http://www.temodar.com. Accessed Oct. 4, 2013.
  10. Taking time: Support for people with cancer. National Cancer Institute. http://cancer.gov/cancertopics/takingtime. Accessed Oct. 4, 2013.
  11. Brain SPOREs. National Cancer Institute. http://trp.cancer.gov/spores/brain.htm. Accessed Oct. 9, 2013.
  12. Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. Aug. 2, 2013.

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