Treatment

Treatment can involve surgery, radiation therapy, and chemotherapy. Brain tumors are best treated by a team involving a neurosurgeon, radiation oncologist, oncologist, or neuro-oncologist, and other health care providers, such as neurologists and social workers.

Early treatment often improves the chance of a good outcome. Treatment, however, depends on the size and type of tumor and the general health of the patient. The goals of treatment may be to cure the tumor, relieve symptoms, and improve brain function or the person's comfort.

Surgery is often necessary for most primary brain tumors. Some tumors may be completely removed. Those that are deep inside the brain or that enter brain tissue may be debulked instead of entirely removed. Debulking is a procedure to reduce the tumor's size.

Tumors can be difficult to remove completely by surgery alone, because the tumor invades surrounding brain tissue much like roots from a plant spread through soil. When the tumor cannot be removed, surgery may still help reduce pressure and relieve symptoms.

Radiation therapy is used for certain tumors.

Chemotherapy may be used along with surgery or radiation treatment.

Other medications used to treat primary brain tumors in children may include:

• Corticosteroids, such as dexamethasone to reduce brain swelling
• Osmotic diuretics, such as urea or mannitol to reduce brain swelling and pressure
• Anticonvulsants, such as evetiracetam (Keppra) to reduce seizures
• Pain medications
• Antacids or histamine blockers to control stress ulcers

Comfort measures, safety measures, physical therapy, and occupational therapy may be needed to improve quality of life. The patient may need counseling, support groups, and similar measures to help cope with the disorder.

Patients may also consider enrolling in a clinical trial after talking with their treatment team.

Legal advice may be helpful in creating advanced directives such as a power of attorney.

Support Groups

For additional information, see cancer resources.

Complications

• Brain herniation (often fatal)
  • Uncal herniation
  • Foramen magnum herniation
• Loss of ability to interact or function
• Permanent, worsening, and severe loss of brain function
• Return of tumor growth
• Side effects of medications, including chemotherapy
• Side effects of radiation treatments

Calling your health care provider

Call your health care provider if you develop any new, persistent headaches or other symptoms of a brain tumor.

Call your provider or go to the emergency room if you start having seizures, or suddenly develop stupor (reduced alertness), vision changes, or speech changes.

References

1. Buckner JC, Brown PD, O'Neill BP, Meyer FB, Wetmore CJ, Uhm JH. Central nervous system tumors.Mayo Clin Proc. 2007;82(10):1271-1286. [PubMed]
2. Stupp R, Roila F; ESMO Guidelines Working Group. Malignant glioma: ESMO clinical recommendations for diagnosis, treatment, and follow-up. Ann Oncol. 2009;20 Suppl 4:126-128. [PubMed]
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Central nervous system cancers. V.2.2009.
4. Wen PY, Kesari S. Malignant gliomas in adults. N Engl J Med. 2008 Jul 31;359(5):492-507. [PubMed]