Types of treatment for brain tumours

This page gives an overview of treatment for brain tumours. There is information about

A quick guide to what's on this page
Your treatment team
How your specialists decide on treatment
Surgery
Radiotherapy
Chemotherapy
Treatment for particular types of brain tumour

Types of treatment for brain tumours

The most suitable treatment for a brain tumour depends on the type of tumour. It also depends on the position in the brain and the tumour size and grade. A team of health professionals work together to decide on the best treatment for you. Your specialists will also consider your age and general health, and your own wishes about your treatment.

Surgery

Removing a growing brain tumour is important because as the tumour gets bigger it increases the pressure inside the head. It is this increased pressure that causes some of the symptoms of brain tumours. The surgeon may be able to remove the whole tumour. Even if your surgeon doesn’t think your brain tumour can be completely removed, they are still likely to want to take out as much as possible.

Radiotherapy

Your specialist may suggest radiotherapy after surgery, or possibly as a treatment on its own. You may have radiotherapy just to the tumour, or you may have it to the whole brain or the brain and spine.

Chemotherapy

Your specialist is most likely to recommend chemotherapy to help relieve symptoms in advanced brain tumours or tumours that have come back.

CR PDF Icon You can view and print the quick guides for all the pages in the treating brain tumours section.

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 (oncologists)
Radiotherapy doctors (radiotherapists)
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.

Surgery may be used for any of the following reasons.

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 the 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 they may not need surgery straight away, or even at all.

Even if your surgeon doesn't think that your brain tumour can be completely removed, 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.

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 which of the following areas they need 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

Specialists now use some new types of radiotherapy for certain types of brain or spinal cord tumours. These include stereotactic radiotherapy (gamma knife or cyberknife treatment) and radiosurgery. 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 the CancerHelp UK section about radiotherapy for brain tumours.

Your specialist is most likely to recommend chemotherapy to help relieve the symptoms of advanced brain tumours or brain tumours that have come back. It is difficult for most chemotherapy drugs to get into the brain to reach the cancer cells. Many drugs can't get from the bloodstream into the central nervous system because the membranes around the brain and spinal cord block the drugs (called the blood-brain barrier). But some chemotherapy drugs can cross the blood-brain barrier. Some drugs can be injected into the fluid inside the spine, which circulates around the brain. Doctors call this intrathecal treatment.

Temozolomide is one chemotherapy drug for brain tumours you take 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 chemotherapy implants are put into the area where the brain tumour was. 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.