If you have a malignant brain tumour, you’ll usually need surgery to remove as much of the tumour as possible. Radiotherapy and chemotherapy are then used to treat any remaining tumour tissue.
However, most malignant brain tumours return after they have been treated. At this point, the aim of treatment is to extend life for as long as possible and treat any symptoms (see below).
This page explains the treatment options for both primary and secondary brain tumours (those that started in the brain and those that spread to the brain from elsewhere in the body).
Primary tumours
Surgery
Most primary tumours will be removed using surgery. They will then usually be treated with radiotherapy and chemotherapy afterwards (see below), to reduce the risk of the tumour coming back.
Surgery aims to remove as much of the tumour as possible, without damaging the surrounding tissue.
You are given a general anaesthetic (put to sleep) and an area of your scalp is shaved. A section of the skull is cut out as a flap to reveal the brain and tumour underneath. This is known as a craniotomy. The surgeon can then remove the tumour.
You may then be given photodynamic therapy, where the surgeon injects a light-sensitive drug into your veins, which is taken up by the remaining cancer cells. When a laser is focused on these cancer cells, the drug becomes active and kills them.
Chemotherapy and radiotherapy
Some tumours that are situated deep inside the brain are difficult to remove without damaging surrounding tissue. In this case, the tumour may just be treated with chemotherapy and radiotherapy (or both).
During radiotherapy, a dose of high-energy radiation is focused on the tumour to stop the cancer cells multiplying. The radiation is a lower intensity than that used in radiosurgery (see below), and is given over a period of time.
Radiotherapy can cause tiredness, headaches, hair loss, nausea and reddening of your skin.
Chemotherapy is medication used to kill any cancerous cells, and may be given as tablets, an injection or implants. Carmustine and temozolomide are both chemotherapy drugs used in the treatment of high-grade brain tumours, and are described below.
Carmustine implants are small wafers that are placed at the tumour site when the tissue has been surgically removed. As they dissolve, they release carmustine to slow or stop the growth of cancerous cells.
Carmustine implants may be used to treat gliomas that are in an advanced stage of growth. In 2007, NICE issued guidelines on the use of Carmustine implants to treat gliomas. NICE has approved them as treatment for newly diagnosed malignant gliomas, but only where 90% or more of the tumour has been surgically removed.
Carmustine implants need to be implanted immediately following surgery and before surgery is complete. This means your surgical team must be prepared to use them in advance if the removal of 90% of the tumour looks possible.
Possible side effects of carmustine implants are brain oedema (fluid in the brain), seizures and infection in the brain. For full details, see the summary of product characteristics.
Temozolomide is a chemotherapy drug that is given to some patients with a malignant glioma to slow down progression after initial treatment, or if the tumour has returned.
Possible side effects of temozolomide include anorexia, constipation, fatigue, headache, nausea and vomiting. For full details, see the summary of product characteristics.
Read more in the 2001 NICE guidelines on Temozolomide for recurrent malignant glioma.
Radiosurgery
Radiosurgery involves focusing a high-energy dose of radiation on the tumour to kill it. It is different to radiotherapy in that the radiation is:
- a higher intensity
- focused on a smaller area of the brain
- given in one session (rather than over a period of time)
This means you will usually not experience any of the usual side effects of radiotherapy, such as skin reddening and hair loss. Recovery is good and an overnight stay is usually not required.
However, radiosurgery is only available in a few specialised centres across the UK.
Secondary tumours
A secondary brain tumour indicates serious, widespread cancer that usually cannot be cured. Treatment aims to improve symptoms and to prolong life by shrinking and controlling the tumour. Treatment may include:
- corticosteroids, which are tablets to reduce the swelling and pressure in the brain
- chemotherapy and radiotherapy (see above)
- anticonvulsant medicines, which prevent epileptic fits
- painkillers to reduce headaches
- anti-nausea drugs, which can help to relieve sickness caused by increased pressure inside the skull
