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Treatment

The treatment options for brain tumour and brain cancer patients are not extensive; a summary of those available is provided below together. Treatment varies significantly case by case.

Overview

People with brain tumours have several treatment options as follows: surgery, radiotherapy, chemotherapy and other drug therapies.

Treatment for brain tumours is based on many factors such as:

  • Patient age, overall health and medical history
  • Type, location and size of the tumour
  • How likely the tumour is to spread or recur, or how fast the tumour is growing
  • Patient tolerance for specific medications, procedures or therapies

Decisions about the best course of treatment will be made together with the patient and their medical team—there is no ‘one-size-fits-all’ treatment option for brain cancer.

The medical team, also called a multidisciplinary team, can include neuro-oncologists, medical oncologists, radiation oncologists, surgeons, nurses, social workers, rehabilitation therapists, neuropsychologists, and other specialists.

In Australia, some people may be offered the option of participation in a clinical trial to test new ways of treating brain cancer. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment.

Read more about clinical trials here.

Standard treatments

Surgery

Surgery is usually the first treatment used for a brain tumour.

The aim of surgery is to remove as much of the tumour as possible, while minimising damage to surrounding healthy brain.  Sometimes it is not safe or possible to remove all visible tumour tissue because it is too close to important areas of healthy brain.

Other aims of surgery are:

  • to provide a large specimen for examination by the pathologist, to confirm the diagnosis and help guide treatment
  • to relieve the pressure on the brain. This can improve symptoms and may reduce the amount of drugs the person needs to control symptoms
  • to reduce the amount of remaining tumour to be treated with radiotherapy and chemotherapy. These treatments may be better tolerated and have less side effects if there is less tumour left to treat.

If the brain tumour is located near a part of the brain that controls speech, or movement or some other vital function, it is common to perform the operation when the patient is awake for a short part of the surgery.  The patient is woken once the surface of the brain is exposed and special electrical stimulation techniques are used to locate the specific part of the brain that controls speech, movement, or vision. This avoids causing damage while removing the tumour.

Sometimes a tumour cannot be removed because it would be too dangerous. This is called an irresectable or unresectable tumour. In this case, the medical team will discuss other treatment options with the patient to ease symptoms.

Radiotherapy

X-rays and other forms of radiation can destroy tumour cells or delay tumour growth.  Radiotherapy is recommended for all people with high-grade tumours if they are well enough to have this treatment, because it can prolong their survival.

Radiotherapy starts as soon as possible after the diagnosis of high-grade tumour; usually two-to-six weeks after surgery, when the surgical wound has healed. Treatment generally takes place Monday to Friday for about six weeks.

Radiotherapy may be given when the tumour is growing or becoming more invasive, or when surgery is unsuitable.  

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide.

The goal of chemotherapy can be to destroy cancer cells remaining after surgery, slow a tumour’s growth, or reduce symptoms. Chemotherapy is typically given after surgery and possibly along with radiotherapy. Chemotherapy drugs may be delivered intravenously or directly into the cerebrospinal fluid (CSF), via injection, or orally.

Chemotherapy is recommended for all patients with glioblastoma multiforme (GBM) who are well enough for the treatment. Chemotherapy normally begins at the same time as radiotherapy and normally continues for six months after radiotherapy.  For people with lower grade tumours, such as grade III astrocytoma, if chemotherapy is used, it is given after radiotherapy.

In some cases, implants containing a chemotherapy drug are inserted during surgery into the cavity left after the visible tumour is removed.

Other treatments

Radiosurgery

Traditional forms of radiotherapy expose both healthy and tumour tissue to high doses of radiation to reduce tumour growth. Newer methods of radiotherapy - called radiosurgery - are highly precise, exposing only tumour tissue and minimal surrounding tissue to the radiation. Through precise targeting of the tumour higher doses of radiation can be used, reducing the number of doses needed and the risks and side effects associated with the treatment. 

Cyberknife

The CyberKnife, delivers multiple beams of x-rays using a robotic arm. It is image-guided so can adjust to the natural movements of the organs and work anywhere in the body. It is used for the treatment of certain lung, brain, spine, liver and prostate cancers which otherwise may be inoperable, or where other treatment options may compromise other vital organs. CyberKnife treatments are delivered in one session or can be staged over several days. Typically brain cancer treatments are completed within five days. For most patients the CyberKnife treatment is a completely pain-free experience.

The only CyberKnife currently available in Australia is located at the Sir Charles Gairdner Hospital in Perth, Western Australia. 

Gamma Knife 

The Gamma Knife delivers gamma rays to a highly-defined target within the brain. The Gamma Knife utilises a lightweight frame to hold the head in place and provide a reference point for targeted radiosurgery. Imaging is performed prior to radiation treatment to ensure that the Gamma Knife’s beams are focused on the tumour site. Working together, neurosurgeons and radiation oncologists identify the target and develop a plan to deliver an extremely accurate dose of radiation while reducing exposure to sensitive healthy tissue. Treatment sessions can last from a few minutes to an hour. 

Gamma Knife surgery is performed at Macquarie University Hospital in Sydney, New South Wales. The first Gamma Knife technology to be made available in a public hospital in Australia is at the Princess Alexandria Hospital in Queensland, with the first patients expected to be treated from September 2015. 

Proton Beam therapy 

Proton beam therapy is an advanced form of radiotherapy which targets tumours with great precision and where the radiation dose can be significantly and safely increased to help eradicate the cancer. Protons are positively charged particles found in the nucleus of every atom. Protons are made available in this therapy by stripping away electrons from hydrogen atoms. As protons move through the body they slow down, causing greater damage to surrounding cells. Due to this unique property, Proton Therapy causes minimal damage to healthy tissue as it enters the body and almost no damage to tissue as it exits the body, unlike traditional radiation therapy. As a result, the radiation oncologist can increase the dose to the tumour while reducing the dose to surrounding normal tissues. Proton therapy is used in the treatment of certain solid cancers in children, tumours of the eye and base of skull, and is becoming the treatment of choice for cancers of the head and neck, brain and spine, prostate, lung, gastrointestinal tract and breast. 

There are currently no Proton Therapy facilities in Australia. The first Proton Therapy centre is scheduled to open in 2017 at The Mater in Queensland.  

Other drug therapies

Other drugs used to treat people with brain tumours include:

Pain medication to help manage the pain from headaches, a common symptom of a brain tumour. Often, drugs call corticosteroids are used to control pain without the need for prescription pain medications.

Anti-seizure medication to help control seizures. There are several types of drugs available.

Corticosteroids are also used to decrease the amount of swelling in the brain.
 

Treatment challenges

Chemotherapy used to treat brain cancer is restricted to a small number of drugs that can cross the blood-brain barrier. Surgery requires a highly skilled team of health professionals to remove as much of the tumour as possible while avoiding damage to normal tissue essential for brain function.   The planning and precision of radiotherapy is essential to avoiding damage to normal brain tissue.

Useful Links

For more detailed information about brain tumour treatment and care visit:
 
Cancer Australia  

Cancer Council Australia

“Adult gliomas: a guide for patients, their families and carers” Cancer Council Australia.