Once your scan shows a suspected brain tumor, your next step will be a consultation with specialists who focus on the brain and central nervous system, such as a:
- neurosurgeon (surgeon who operates on the brain and nervous system)
- neuro-oncologist (doctor who specializes in treating nervous system cancers)
- radiation oncologist (doctor who uses radiation to treat cancer)
Your care team should include a multidisciplinary group of health care professionals that help you make treatment decisions. The team will need to balance the treatment for the primary cancer site with the treatment for the metastatic brain tumor. They will look at your scans to determine if the tumor(s) can be surgically removed, or if other treatment options would be more reasonable for you.
Treatment decisions will take into account not only long term survival possibilities, but your quality of life during and after treatment, as well as cognition concerns. When planning your treatment, your doctors will take several factors into consideration.
- Your history of cancer
- The status of that cancer
- Your overall health
- Number and size of metastatic tumors
- Location of the metastatic tumor(s) within the brain or spine
- The tumor’s response to past therapy and its potential response to future treatment
The three main categories of treatments for metastatic brain tumors include surgery, radiation and medical therapy (chemotherapy, targeted therapy or immune-based therapy). Your doctor may suggest a combination of these therapies.
As in any disease, there are possible side effects from brain tumor treatment. Ask your doctor to explain these effects. He or she can also help you and your family balance the risks against the benefits of treatment.
Whole-brain radiation is a common form of radiation for metastatic brain tumors, especially when multiple tumors (more than three) are present. The goal of this therapy is to treat both the tumors seen on the imaging scan plus the tumors that are too small to be visible. As a result, whole-brain radiation may be both preventive and therapeutic.
An important and common concern about whole-brain radiation is its possible impact on cognition and thinking, as a large section of the brain is effected by the radiation. Research focused in this area is ongoing.
Stereotactic radiosurgery (SRS) is a special form of radiation therapy. SRS, is a special type of radiation that allows precisely focused, high-dose x-ray beams to be delivered to a small, localized area of the brain. Because SRS focuses the beams more closely to the tumor than whole-brain radiation, it can deliver a higher, more effective dose of treatment to the tumor site.
Recent advances have made stereotactic radiosurgery an effective treatment option for some patients with brain metastases. Radiosurgery focuses high doses of radiation beams more closely to the tumor than whole brain radiation in an attempt to avoid and protect normal surrounding brain tissue. This approach is most commonly used in situations where there are fewer than three tumors and the tumors are relatively small (3 cm or less in diameter). Another consideration is whether the tumors are in eloquent regions of the brain, for example, speech and motor localized areas.
Radiosurgery can also be used to treat tumors that are not accessible with surgery, such as those deep within the brain. It may also be used for recurrences if whole-brain radiation was previously given, or as a local “boost” following whole-brain radiation. Examples of stereotactic radiosurgery machines are the LINAC radiosurgery, Gamma Knife or CyberKnife.