Treatment for brain tumors: therapies, surgery and recovery.

Treatment options for a tumor mainly depend on the size, type, location and on the age and general health of the patient. Brain tumors (primary or metastatic, benign or malignant) are usually treated with surgery, radiation, and/or chemotherapy alone or in various combinations. Surgery It is generally accepted that complete or nearly complete surgical removal of a brain tumor is beneficial to a patient. The main goal of surgery is to remove as much of the tumor as possible without injuring brain tissue important to the patient's neurological function (such as the ability to speak, walk, use the hands, etc.). If the tumor cannot be completely removed, surgery can still reduce or control its size. New surgical techniques can minimize the risk and discomfort of surgery. Minimally invasive techniques can be used to remove some brain tumors through the nose or through small openings at the base of the skull. In most cases, surgeons create an opening in the skull (or “craniotomy”) just large enough to ensure they can get to a tumor. Subtle differences in appearance between normal and tumor tissue are used to guide removal. Sometimes a biopsy is obtained before proceeding with a larger operation. Biopsy can be obtained through a minor craniotomy or with special guiding techniques to obtain a “stereotaxic biopsy”.

Stereotactic biopsy

It is performed when a neurosurgeon uses a small instrument that is guided in three dimensions to remove a small sample of tissue from an area of ​​the brain. Computers are used to determine accurate information about the location of the tumor from a CT or MRI scan. Often, a small piece of tumor can be retrieved through an opening in the skull that is only a few millimeters wide. The purpose of a biopsy is to obtain a small tissue sample to guide doctors in determining the best treatment plan.

Sophisticated surgical navigation systems

They are used to support the surgeon with location and orientation (neuronavigation). These systems allow surgeons to accurately correlate a position within the brain with what is seen on the image (CT, MRI and angiograms). This guidance information can reduce risks and improve the extent of tumor removal.

Accumulation of cerebrospinal fluid

Some patients have or will develop a problem with the circulation or absorption of spinal fluid. Cerebrospinal fluid (CSF) is produced within the brain, travels through the ventricles of the brain and spinal column, and is absorbed at the surface of the brain. If flow is blocked, or if fluid absorption is impaired, fluid can build up and put pressure on the brain. Fluid buildup can be treated by draining the fluid externally or internally to another part of the body in a procedure called a shunt. Fluid usually drains from the ventricles of the brain into the abdomen (ventriculo-peritoneal shunt or better known as Ventriculoperitoneal Shunt). The choice of treatment and the decision on when to have an operation must be determined by a neurosurgeon. It is important to keep in mind that surgery has its limitations. While every precaution is taken to avoid complications, potential risks can include infection, excessive bleeding during and after surgery, difficulty swallowing, stroke, seizures, weakness or paralysis, and other problems. Ask your doctor to talk to you about possible side effects.

Radiation

It is a commonly used treatment for brain tumors. This affects both normal and tumor cells. The goal of radiation therapy is to selectively kill tumor cells while leaving normal brain tissue unharmed. This can be done in two ways. In standard external beam radiation therapy, multiple treatments of standard dose “fractions” of radiation are delivered to the brain. Each treatment induces damage to healthy, normal tissue. By the time the next treatment is given, most normal cells have repaired the damage, but the tumor tissue has not. This process is repeated for a total of 10 to 30 treatments (depending on tumor type). Ideally, 98% of the tumor is killed and 98% of the normal tissue survives.

Radiosurgery

The second way to selectively kill tumor cells is to focus an intense dose of radiation on the tumor from many points around the head. This process is called radiosurgery and it uses special computers and methods to deliver radiation to carry out the treatment. The tumor receives a relatively large amount of radiation, but the radiation dose to the surrounding normal brain is very low because the radiation delivered has been spread across so many different delivery points on the surface of the brain. These many delivery points converge on the tumor tissue. Radiosurgery was used both as an alternative and in combination with radiation and/or conventional surgery. “Sterotactic radiotherapy”, or “fractional radiosurgery”, can be used to administer multiple low-dose radiation treatments by matching the form of radiation delivered to the lesion. More radiation can be given to the tumor, and less to the surrounding normal brain. This technique improves the safety and efficacy of radiotherapy. It also allows treating tumors larger than those that can be managed with conventional radiosurgery. Depending on the type of tumor, there are two pieces of medical equipment commonly used for the transmission of stereotaxic radiosurgery, a linear accelerator (LINAC) and a Gamma Knife. LINAC will deliver focused X-ray beams to the tumor. The Gamma Knife delivers low-intensity gamma rays to the tumor. The risks of radiation therapy include injury to normal tissue outside the tumor. For long-term survivors, there is also a risk of developing a second cancer as a result of radiation affecting adjacent normal tissue. While it is true that radiation and chemotherapy are most often used for malignant, residual or recurrent tumors, decisions about which treatment to use are made individually for each patient and depend on a number of factors. New combinations of therapy are being developed every year.

Chemotherapy

Chemotherapy uses special drugs designed to kill tumor cells. Chemotherapy can be a primary (first) therapy or an adjuvant (additional) therapy. However, not every brain tumor will respond to chemotherapy. Chemotherapy treatment can be administered in a hospital, outpatient clinic, doctor's office or even in the patient's own home. Treatment cycles vary depending on the drug (or drugs) being used. Chemotherapy affects both normal and tumor cells, so the amount that can be given is often limited by side effects on normal cells. Tissues with the fastest growing cells are most affected. Thus, such tissues as the hair, the lining of the mouth and stomach, and the bone marrow (which produces blood cells) may be more obviously affected. Newer chemotherapy has improved overall survival in patients with more malignant brain tumors. These newer treatments are still not cures, but they have extended the time that patients with malignant brain tumors have been able to enjoy a good quality of life. The standard of care for the most malignant primary brain tumors now involves radiation and chemotherapy given together early in the patient's course of treatment. Chemotherapy works by causing cell damage that is better repaired by normal tissue than by tumor tissue. The aim of another class of drugs is not to kill tumor cells, but rather to block further tumor growth. In some cases, growth modifiers have been used to stop the growth of tumors resistant to other treatments. An exciting new class of treatment called antiangiogenesis uses drugs to combat the tumor's ability to recruit and form new blood vessels. In a sense, this can cut the tumor's supply lines and stop its growth. A surgeon may also use chemotherapy-impregnated “lozenges” at the time of surgery. The lozenges slowly secrete a chemotherapeutic agent into the tumor region. Additional experimental therapies involve direct infusion of chemotherapy agents into the brain or into the blood vessels leading to the brain.

Investigational therapies

They are a reasonable option if a tumor comes back after standard treatment with radiation and chemotherapy. Investigational therapies are still in their experimental phase, so results may not be substantiated. However, most are based on promising research developments and patients are encouraged to participate in these studies.

Gene therapy

Gene therapy may be an option for treating brain tumors. Gene therapy is the transfer of genetic material into a tumor cell to destroy the cell or stop cell growth. This treatment aims to correct the underlying defects in the genes that led to the initial formation of the tumor.

Immunotherapy

It involves new treatments that rely on the body's immune system to kill tumor cells. Tumor vaccine, a popular example of this type of investigational therapy, is another new area of ​​research. This strategy attempts to harness a person's own immune system to fight the brain tumor. It is still too early to say how successful this technique will be, but it is under investigation for tumors in other parts of the body, as well as brain tumors.

Recovery after surgery

After the surgical procedure, the patient is taken to the intensive care unit (after perhaps spending a short time in the recovery room) for close observation. The patient will then be discharged from the hospital as soon as his doctor feels it is appropriate. The doctor will give you appropriate medications to prevent or treat potential problems.