Brain Cancer Treatment
Once the diagnosis of brain cancer is made, you and your family can be faced with many difficult decisions to make about your brain cancer treatment options. Factors to consider include the extent of resection (how much of the tumor was removed during surgery), type of tumor and status of important markers like chromosomes or enzymes, your ability to function and your age.
The most important factor in determining a treatment course is to consider your wishes and willingness to accept different levels of side effects in order to benefit from the treatment. When your care team recommends a treatment, they will listen to you, respect your decisions and walk the journey with you.
Brain Cancer Treatment Options
Your care team’s job is to fully describe your brain tumor treatment options, including the risks and benefits of each. Before recommending treatments, we will need to review records of medical care that you have previously received from any care provider.
This includes MRI scans, treatment history and full pathology, which may lead to a request for our neuropathologist to give a second opinion of the tumor specimen. This review allows us to present the full range of appropriate treatment options for you. Our tumor board, which includes specialists from neurosurgery, neuroradiology, neuropathology, radiation oncology and neuro-oncology, will discuss MRI scans and pathology findings together to collaborate on a recommendation for treatment.
Even in the best circumstances, a tumor can be hard to treat. Brain tumor surgery requires great emotional commitment and time to recover before additional treatments can begin. However, surgery is the single best way to quickly and effectively decrease the number of tumor cells in the body. Brain tumor surgery also potentially removes the bulky tumor which gets only limited blood flow and, if left in place, would allow tumor cells to hide from radiation and chemotherapy.
Both radiation therapy and chemotherapies work better if we are treating microscopic tumor cells versus a large tumor. These therapies work less well if we try to shrink a large tumor mass. Other factors that can make a tumor more difficult to treat include limited blood flow to the tumor, tumor cells resting in low-oxygen/low-nutritional environments in the center of the tumor, and a limited ability for chemotherapies to reach all parts of the tumor.
Most importantly, in addition to providing you with the best outcome, your surgical team will discuss with you approaches to minimize the risk of your surgery. While surgical risk can never be zero, a skilled and appropriately aggressive neurosurgeon who is equipped with advanced surgical tools can make surgeries as safe as possible.
The University of Kansas Cancer Center offers advanced techniques and technologies to remove all or as much of the brain tumor as safely as possible:
- 3D navigation: 3D navigation is used during neurosurgery, allowing surgeons to precisely pinpoint a location within the brain in all 3 planes (axial, coronal and saggital). The surgeon can use this throughout the procedure as a map that highlights where the tumor ends and normal brain tissue begins.
- Functional MRI brain mapping: When appropriate, we offer functional MRI brain mapping, a technique that allows surgeons to locate specific areas of the brain before surgery so they can determine the best approach to the tumor. The technique helps surgeons avoid critical areas of the brain that control movement, speech and other functions.
- Awake craniotomy: In some cases, a craniotomy can be performed while you are awake. Your doctor awakens you from anesthesia after the initial incision is made. You are then asked to perform tasks while the surgeon operates close to a critical area.
For some people, minimally invasive neurosurgery techniques can be considered. The neurosurgeon uses an endoscope (a thin tube with a light and camera at the end) to access difficult-to-reach areas of the brain. There are 2 types of minimally invasive endoscopic procedures:
- Transventricular endoscopic surgery: The surgeon guides the endoscope into the ventricular system, which consists of multiple spaces in the brain that are filled with spinal fluid. This procedure can be used to treat hydrocephalus (a buildup of fluid in the brain ventricles) or remove certain cysts and tumors.
- Endonasal endoscopic brain surgery: The surgeon guides the endoscope through the nose to perform surgery at the skull base. This can be done for pituitary adenoma, certain skull base tumors and some malignant tumors.
The advantages of endoscopy include lower infection rate, faster recovery and less damage to normal brain tissue.
A radiation oncologist has spent years studying the delivery of radiation therapy for the treatment of tumors, including cancers. While there are a number of different types of radiation, the goal is to damage the tumor cells while sparing surrounding healthy tissue as much as possible. Delivery of radiation has improved greatly over the years to allow treatment delivery to very precise locations. Radiation can treat many types of brain tumor to either stop growth or reduce the chance of recurrence. Your radiation oncologist will discuss specific treatment details with you, as well as strategies to minimize side effects.
Stereotactic radiosurgery (SRS) is a specialized form of radiation that delivers a very high dose of radiation to a very precise area in only 1 or a few treatment sessions. It can very effectively kill tumor cells in the target area and is often used in the treatment of metastatic tumors. In addition to SRS equipment such as the Gamma Knife and Cyber Knife, we offer advanced Novalis Tx™ image-guided radiosurgery at The University of Kansas Cancer Center. We are the Kansas City region's only hospital to offer this advanced, noninvasive treatment for all types of brain tumors.
The University of Kansas Health System also offers brachytherapy, a form of radiation therapy for brain tumors. In this procedure, radioactive seeds are placed directly into or around the tumors while sparing the surrounding healthy tissue.
Proton therapy is the leading-edge form of radiation treatment currently available. Proton therapy is a form of external beam radiation that uses energized protons to deliver radiation to a tumor. Proton therapy allows us to target and focus the radiation much more precisely, concentrating radiation in the tumor, where it will benefit the patient, and minimizing radiation to the surrounding healthy tissue. As a result, proton therapy may offer patients the possibility of fewer side effects and improved quality of life, both during and after treatment.
Neuro-oncologists provide ongoing care and management for brain and spine tumors, working closely with the rest of the care team. The most commonly used treatment these specialists offer is chemotherapy or chemical therapy. Chemotherapy can essentially refer to any medication designed to kill cancer cells. Chemotherapy is the traditional chemical treatment that can come in the form of pills (oral) or infusions (IV).
These therapies are relatively nonspecific, which means they can affect both cancer cells as well as normal body cells. Unlike surgery or radiation, the advantage of chemotherapy is that it can go almost anywhere in the body attacking cancer cells wherever they may be, even microscopic tumor deposits that can’t be seen with MRI. However, this is also the disadvantage of chemotherapy.
Targeted therapies treat only specific cancer cells, delivering a greater impact to the tissue with high levels of these cells while sparing healthy tissue that has low levels or none of these cells.
Generally, immunotherapy works to “teach” the immune system to recognize the markers on tumor cells as targets and attack the tumor in a sustained way. The idea is that this will offer a safer, effective and long-lasting result.
FDA-approved therapeutic transmissible fields technology (Optune®) is available at The University of Kansas Cancer Center. The technology is based on the observation that cell division can be stopped by exposing cancer cells to an alternating electric field. For those with a new brain cancer diagnosis, Optune is used with the chemotherapy temozolomide (TMZ) after surgery and radiation with TMZ. For recurrent cases, it can be used alone when surgery and radiation treatment options have been exhausted. In a clinical trial, adding Optune to TMZ was proven to delay GBM tumor growth and extend survival in newly diagnosed patients compared with TMZ alone.
In addition to cancer treatment, your neuro-oncologist will help you manage your seizure medicine, or if needed, recommend a seizure specialist. Other areas of supportive care can include management of corticosteroids like Dexamethasone, treatment of depression and helping to control other symptoms potentially affecting your quality of life.
Studies have shown that good control of symptoms such as pain not only improves day-to-day enjoyment of life, but actually can improve survival. Our neuro-oncologists are focused on supporting you and your family in achieving the best outcome and quality of life throughout the cancer journey.
Life after brain cancer
Surviving cancer is a lifelong process. Each person faces different challenges physically, cognitively and emotionally together with their families. Your care team will often recommend regular checkups and MRI scans. At these visits, we can continue to help address any of the ongoing symptoms of either tumor or treatment.