Types of treatment for brain tumours

NHS guidelines say that everyone with a brain tumour should be under the care of a multi disciplinary team (MDT). An MDT is a team of health professionals who work together to decide on the best way to care for you. There are 2 different types of MDT involved in treating brain and central nervous system tumours. These teams work closely together, and some staff might belong to both teams.

The team you first see is the neuroscience MDT. This team is responsible for planning the first stages of your treatment, including surgery. After surgery, or if surgery is not possible, you will be under the care of the cancer network MDT. This team is responsible for providing further treatment and support, including radiotherapy and chemotherapy.

The specialist MDTs are likely to include the following health professionals

• Brain surgeons (neurosurgeons)
• Brain specialists (neurologists)
• Cancer specialist doctors (medical oncologists)
• Radiotherapy doctors (clinical oncologists)
• Clinical nurse specialists
• Psychologists who work with people with brain disorders (neuropsychologists)
• Palliative care specialists, for help with controlling symptoms
• A neuroradiologist (specialist in neurological scans)

The MDTs might also include other professionals such as physiotherapists, dieticians, speech therapists and occupational therapists.

The most suitable treatment for any brain tumour depends on the following things.

• The type of brain tumour
• The position of the tumour - how near it is to vital or delicate parts of the brain
• Size of the tumour
• Grade of the tumour
• Your age

It may be possible to remove a particular type and grade of tumour with surgery. But the same type and grade of tumour may not be removable if it is growing in a very delicate area of the brain. If the surgery would cause too much damage, your specialist may suggest a different type of treatment. As well as the factors above, your surgeon will need to consider the following things.

• Your general health
• Your medical history
• Your own wishes about your condition and treatment

Your doctors will discuss your options with you. If you have other medical conditions that make it risky for you to have a major brain operation, your doctors can plan other treatment options that may be more suitable for you.

Surgery, radiotherapy and chemotherapy are all used to treat brain tumours. New treatments are being developed all the time for brain tumours that respond poorly to treatment, or are in parts of the brain that are difficult to reach. A combination of treatments may be the best way of removing or controlling your tumour.

You may have surgery for a brain tumour

• To remove the whole tumour
• Remove most of the tumour (called a subtotal resection or debulking)
• To take a biopsy of the tumour
• To remove all or part of a growing benign tumour

Removing a growing tumour is important because the inside of the skull is a fixed size. If a tumour gets bigger, it takes up more space and increases the pressure inside your head. It is the increased pressure that causes some of the symptoms of brain tumours. Very low grade, slow growing brain tumours may not develop quickly enough to cause these problems. So for a very slow growing tumour, you may not need surgery straight away or even at all.

Even if your surgeon doesn't think they can completely remove your brain tumour, they are still likely to want to take out as much of it as possible. This is called subtotal resection or debulking. It can help by slowing down the progress of the tumour and relieving symptoms. It also makes it easier to treat the tumour cells left behind with radiotherapy or chemotherapy. With smaller tumours it is easier for treatment to reach all the cancer cells, particularly in the centre of the tumour.

We have  a whole section on brain tumour surgery with more detail on what will happen.

Your specialist may suggest radiotherapy after surgery or possibly as a treatment on its own. Depending on your type of treatment, your doctor will decide to treat

• Just the tumour or tumour bed (where the tumour was before it was removed)
• The tumour (or tumour bed) plus a surrounding margin of healthy brain tissue
• The whole brain
• The whole brain and spinal cord

For certain types of brain or spinal cord tumours, specialists may use stereotactic radiotherapy or radiosurgery (you may hear the names cyberknife or gamma knife). Stereotactic radiotherapy machines can deliver radiation beams to the head from about 200 different points. So they give a very high radiation dose to the tumour. Radiosurgery is a very precise treatment, with a single very large targeted dose of radiation.

We have information about stereotactic radiotherapy in our section about radiotherapy for brain tumours.

Your specialist is most likely to recommend chemotherapy to help relieve symptoms of advanced brain tumours or brain tumours that have come back after they were first treated. 

It is difficult to get most chemotherapy drugs into the brain to reach the cancer cells. Many drugs can't get from the bloodstream into the central nervous system because they can't get through the tissues surrounding the brain and spinal cord.  This is called the blood-brain barrier. But some chemotherapy drugs can cross the blood-brain barrier. And some can be injected into the fluid inside the spine, which circulates around the brain - doctors call this intrathecal treatment.

Temozolomide is a chemotherapy drug for brain tumours that can cross the blood-brain barrier. You take it as a capsule that you swallow. It works by stopping cancer cells from making new DNA. If they can't make DNA, they can’t split into 2 new cancer cells.

Sometimes surgeons put chemotherapy implants into the area where they have removed a brain tumour. For example, there are wafers that break down slowly inside the brain, releasing a steady amount of a chemotherapy drug for a long time. Specialists may suggest this treatment after surgery. They use the wafers to try to lengthen the time it takes for a high grade brain tumour to come back.

There is a whole section on brain tumour chemotherapy with more detail about what will happen and the drugs doctors use.

The links below will take you to information about treatments for different types of primary brain tumours

• Glioma
• Ependymoma
• Oligodendroglioma
• Gliomas in children
• Meningioma
• Primitive neuroectodermal tumour (PNET)
• Pituitary tumours
• Acoustic neuroma
• Craniopharyngioma
• Haemangioblastoma
• Lymphoma
• Pineal region tumours
• Spinal cord tumours

We also have information about treating secondary brain tumours, where cancer cells have spread to the brain from another part of the body.