Metastatic Brain Tumors

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, will serve as the "quarterback" of the care team. In addition, the neuro-oncologist will counsel the patient about neurologic issues confronting him or her.

Because new treatments continually develop, 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 individual needs of the patient and family.

Treatment for a brain tumor — along with survival odds — depends on the tumor type, size and location, as well as the patient's age and overall health.

Initial Treatment Steps

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 the tumor has resulted in a buildup of fluid 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 abdominal (peritoneal) cavity where the body reabsorbs it.

Treatments to Remove or Reduce the Tumor

The two main treatments for metatstatic brain tumors at Mayo Clinic are radiation and surgery. If a patient has a single metastasis and that tumor is able to be removed surgically, your doctor will likely advise surgery. After surgery, radiation is often needed; this would usually be whole-brain radiation, to try to prevent the growth of tumors not only in the surgery area, but also in other areas of the brain.

In many patients, the big question will be whether to use whole brain radiation or radiosurgery. Both treatments are effective. Radiosurgery is very convenient but because it targets tumors individually, the chance of tumor growth outside of the areas targeted by radiosurgery is high. In many instances, your doctor may choose to use the combination of whole brain radiation plus radiosurgery.

In some instances, the choices will come down to radiosurgery versus conventional surgery. On the whole, the medical literature suggests equivalent outcomes for both therapies. In general, radiosurgery is more convenient, effective, and safe for smaller lesions and for lesions in inaccessible locations. Also, radiosurgery offers a reasonable option for patients who are not surgical candidates for medical reasons. Surgery is clearly the optimal treatment for tissue diagnosis or for tumors that are affecting the patient by pressing on surrounding tissue.

Unfortunately, nearly 50 percent of patients with one or two brain metastases are not candidates for surgery because of the inaccessibility of the tumor, the extensiveness of the systemic disease, or other complicating factors. These patients and others with multiple brain metastases should receive whole-brain radiation as standard therapy. With whole-brain radiation therapy, up to 50 percent of these patients show an improvement in neurologic symptoms, and in 50 percent to 70 percent the tumor shrinks in size.

Chemotherapy is rarely used as a primary therapy for brain metastases.

Experimental Treatments

Mayo Clinic participates in numerous clinical trials for brain and nervous system tumors, include trials originating at Mayo Clinic and those sponsored by the National Cancer Institute through the North Central Cancer Treatment Group (NCCTG).