What are the treatment options available for brain tumors?
Treatment of brain tumors depends on the type and grade of the tumor. Most primary brain tumors require surgical treatment. Surgery provides material for pathological examination for definite diagnosis and relieves the “mass effect” of the tumor. In cases of benign tumors (grade I and II), complete tumor removal provides a cure without additional adjuvant therapy. However, even benign tumors can be challenging if located in deep or sensitive areas. Unlike in other surgical specialties, neurosurgeons do not routinely practice tumor removal with “safety margins” (i.e., removal of the tumor in one piece with some normal tissue around it) since normal tissue removal around the tumor may have devastating consequences for the patient. Rather, the tumor is separated from the normal tissue and removed with minimal damage to the surrounding tissue. In cases of malignant primary brain tumors (grade III and IV), the demarcation zone between the normal and abnormal may not be that clear. These tumors show infiltrative growth patterns – i.e., not only do they develop as mass inside the brain, but also cancer cells dislodge from the main tumor mass to penetrate the normal surrounding brain tissue. In these cases, the surgeon may leave some of this transition zone during surgery in order not to cause neurological deficit. Yet recurrences develop from remaining tumor cells in the surgical field. To impede the growth of remaining tumor cells, radiation therapy (RT) and/or chemotherapy is administered following surgery for malignant brain tumors. Brain tumors do not usually spread to other organs.
Metastatic tumors are the most frequent type of brain tumor. Nowadays, patients with cancer survive longer than ever before due to medical advances. Unfortunately, available treatments are not capable of fully eliminating the tumor from the body. Rather, they impede the progression of cancer. Therefore, the number of patients with metastatic brain tumors is on the rise. Treatment for these tumors should be individualized. In the vast majority of cases, these patients already had surgery and/or RT with chemotherapy for primary disease. General conditions may be poor enough to undergo a major brain surgery. Surgery is reserved for patients with a few metastases (oligometastatic disease), good general condition, and prognosis. There are several metastatic tumor types that are very sensitive to radiation and chemotherapy. In these cases, adjuvant therapy alone is sufficient.
In rare cases, brain metastasis is the only clinical manifestation of cancer. Search for primary origin may not yield a diagnosis. Therefore, surgery can provide pathological specimens for evaluation and diagnosis.
Metastatic brain tumors were once considered unexceptionally lethal. Yet, with modern treatment options, this is not the case anymore. Removing brain metastasis has been shown to prolong the patient’s survival and increase the quality of life. In the vast majority of cases, chemotherapy and radiation therapy are used to control the tumor growth following surgery for brain metastasis.
