What is Brain Cancer Treatment?

The first step in the treatment of a patient with a brain tumor is to get a diagnosis and to frequently remove as much of the tumor as can safely be removed.  At this point you may find that your team of doctors and healthcare professionals broadens and you may meet a medical oncologist or neuroncologist which is a doctor who specializes in giving chemotherapy and medicine to treat tumors. You may also meet a radiation oncologist. That’s not a radiologist. A radiologist looks at x-rays like the MRIs that you probably had. The radiation oncologist treats tumors with radiation and often at this point the neurosurgeon, someone like me, will take a step back on your team and be a supporting member of the team and the medical oncologist partnered with the radiation oncologist will take the lead in treatment. 

Some patients with very low-grade tumors like grade 1 tumors and some grade 2 tumors who are young and have had a very good removal might just elect for observation at this point, meaning we would do a series of MRI scans over months and years to follow for any sign of the tumor coming back. It’s very important for anybody diagnosed with a brain cancer to have a long-term follow-up plan and it would be very unusual after surgery for me to tell a patient that they didn’t need to come back anymore, even if they were only coming back for scans. So if you hear that you don’t need any more MRIs or anything else done it would be very good to ask, and make sure that that’s clearly the point, because most patients will at least get follow-up imaging.  

Many patients with grade two tumors and almost all patients with grade 3 and grade 4 tumors even after the best surgical resection will hear recommendations from their treatment team to consider chemotherapy or radiation therapy. Sometimes the two are given together. It’s very common to set out a treatment plan that would go on for a number of months and it might be that the patient would get radiation as the first step. Maybe with a low dose of chemotherapy given at the same time, then take a brief pause and then move on to getting regular chemotherapy for a defined period of time. Or at that point the period of time may not be known. So you should often expect to hear at this visit about a treatment plan that would involve both radiation and chemotherapy. Obviously this has to be individualized for each patient’s case.