Glioma

Treatment

Treatment of a brain tumor at Mayo Clinic is a team process. Specialists from the brain tumor treatment team 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, serves as the team leader. In addition, the neuro-oncologist will counsel the patient about neurologic issues.

Because new treatments develop continually, several options may be available for patients during 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 each patient and family.

Treatment options and survival odds depend on the tumor type, size and location, as well as the patient's age and overall health. For specifics about treatment, see descriptions of each tumor type:

• Astrocytomas
• Ependymomas
• Glioblastoma multiforme
• Oligodendrogliomas
• Mixed gliomas

Once treated, a glioma may remain in remission for many years, or may never recur. In remission, the tumor cells have stopped growing or multiplying.

During follow-up visits, patients are usually monitored regularly for tumor recurrence with MRI or CT scans.

Initial Treatment

• Steroid medications may be needed to reduce swelling and inflammation of brain tissue.
• Anticonvulsant medications may be prescribed to help prevent or control seizures.
• A shunt may be inserted if fluid has built up in the brain (hydrocephalus). A shunt is a long, thin tube that is placed in the brain and then threaded under the skin to another part of the body, usually the abdomen. The tube allows excess fluid from the brain to drain into the peritoneal or abdominal cavity where it is reabsorbed.

Treatments to Remove or Reduce the Glioma

Surgery
Surgery is the mainstay of glioma treatment and involves removing as much of the glioma as possible, while trying to minimize damage to healthy tissue. Some tumors can be removed completely, and others only partially or not at all. If a glioma is growing slowly, surgeons may not operate immediately but may monitor the tumor closely and wait.

To remove the glioma, the neurosurgeon cuts some bone from the skull to get to the brain, known as a craniotomy. After the neurosurgeon removes the glioma, the bone is reattached and the incision in the scalp sewed up.

Computer-Assisted Brain Surgery
Mayo Clinic surgeons are skilled and experienced in the use of computer-assisted brain surgery, which allows them to remove brain tumors more safely and accurately, while reducing patients' pain and recovery time.

Radiation
Radiation uses high-energy rays to destroy tumor cells. Radiation is often administered after surgery to destroy any remaining tumor cells. It is also an option if surgery is not possible. Radiation therapy generally involves daily treatments for approximately five to six weeks, performed on an outpatient basis.

Stereotactic radiosurgery like stereotactic surgery, uses computer imaging to create maps of the brain, allowing the doctor to deliver killing radiation beams in the exact size and shape of the tumor. Treatments can typically be done in one session.

In brachytherapy, materials that produce radiation (radioisotopes) are placed directly into the tumor to destroy tumor cells from the inside (internal radiation therapy).

Chemotherapy
Chemotherapy, drugs taken by mouth or intravenously, can help kill tumor cells. Sometimes, chemotherapy-coated wafers are placed in the space left after a tumor has been removed to try and prevent recurrence.

Combination Treatments
Many gliomas are treated with a combination of surgery, radiation and chemotherapy.

Clinical Trials
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).