This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on June 8, 2022.
Various treatments are used to treat brain cancer, and a care team will recommend a treatment regimen after considering several factors, including the type of brain cancer, location and the patient's general health.
Each patient's oncology care team will go over the treatment options available, but some of the most common treatments for brain cancer are detailed below.
Surgery by an experienced neurosurgeon to remove the brain tumor, or as much of the tumor that may be safely removed without impacting brain function, is usually the first line of brain cancer treatment. Depending on the size, location and grade of the brain tumor, surgery may be the only treatment necessary, or surgery may be combined with radiation therapy and/or chemotherapy. Surgery may also help relieve some symptoms caused by brain tumors, particularly those caused by a buildup of pressure in the skull. These side effects may include headaches, nausea, vomiting and blurred vision. Surgery may also make seizures easier to control with medicines.
Surgery may not be an option for certain brain tumor types or locations, or if a patient’s overall health precludes it.
The care team at a comprehensive neurosurgical treatment program will provide the patient with a wide range of options for primary brain tumors and brain metastases (tumors that have spread to the brain from other parts of the body). Treatment plans may include traditional surgical approaches (e.g., tumor resection), radiation therapy, chemotherapy and/or immunotherapy.
Brain surgery is typically used to remove all the cancer cells, if possible. In the past, the surgeon would make large incisions to remove the tumor. Today, surgeons are often able to use more minimally invasive surgical techniques.
Where possible, endoscopy, which positions a camera next to the brain tumor, may allow for smaller surgical incisions to be used to perform a complete tumor resection. Potential advantages may include:
Sophisticated tools enhance the precision and safety of brain cancer surgery. These tools allow the removal of tumors that may otherwise have been inoperable, while preserving neurological function:
Intraoperative neuronavigation uses an advanced MRI system to map areas of the brain responsible for important functions. The map then allows the surgeon to precisely plan surgery to avoid damage to those important areas.
Intraoperative electrophysiology “brain mapping” (also called motor mapping and language mapping) is like GPS for the brain. Small electrodes are placed on the outer layer of the brain to stimulate the brain and areas around the tumor. This helps locate regions of the brain to avoid, such as those responsible for speech or movement.
Other treatments may be performed at the time of surgical resection. For example, local chemotherapy, also known as BCNU, targets chemotherapy to the brain tumor and resection area, helping reduce side effects related to systemic chemotherapy, such as nausea and vomiting.
Another treatment under investigational use for brain cancer treatment is intraoperative radiation therapy (IORT). With this technology, radiation is delivered directly to the area of the tumor resection during surgery, helping avoid damage to adjacent normal structures, particularly the scalp and the skin on the scalp. The IORT is typically delivered via brachytherapy, electron beams or X-rays.
Highly targeted radiation therapy may be used to destroy brain tumor cells and to relieve symptoms caused by the tumor. This therapy allows radiation oncologists to increase the dosage and precisely target radiation to the brain tumor, while reducing damage to healthy brain tissue.
Radiation therapy for brain cancer patients may be used after a biopsy, or following surgical resection of a tumor, to help destroy remaining microscopic tumor cells. It may also be an option for unresectable brain tumors or brain metastases, tumors that have spread to the brain from another part of the body.
External beam radiation is commonly used for brain cancer. The area radiated typically includes the tumor and an area surrounding the tumor. For brain metastases, radiation is sometimes delivered to the entire brain.
Because lung cancer commonly spreads to the brain, some lung cancer patients receive whole-brain radiation as a preventive therapy to stop tumors from developing.
Chemotherapy is commonly given to patients with high-grade brain cancer. It may be used alone or in combination with other brain cancer treatments, including brain surgery and/or radiation therapy.
These types of chemotherapy drugs enter the bloodstream and reach areas throughout the body. A challenge with brain cancer chemotherapy is finding drugs that can cross the blood-brain barrier (the natural barrier that protects the brain) to reach tumor cells in the brain.
Chemotherapy drugs may be administered orally in pill form or injected into the vein. For some types of brain cancer, chemotherapy drugs may be given directly into the cerebrospinal fluid (CSF), either in the brain or spinal column. To help with this, a special reservoir under the scalp may be surgically implanted. The reservoir is attached to a tube that leads into a ventricle of the brain where the CSF circulates.
These chemotherapy drugs go directly to the area of the brain tumor at the time of surgical resection. As all or part of the brain tumor is removed, a biodegradable wafer containing the chemotherapy drug is placed in the space left by the tumor or near parts of the tumor that can’t be removed. The wafer slowly releases the chemotherapy over several days.
This technique increases the drug concentration at the tumor site while reducing the side effects typically associated with systemic chemotherapy.
Targeted therapies for brain cancer target specific pathways or abnormalities in brain tumor cells involved in tumor growth. Targeted therapy is often combined with other brain cancer treatments, such as chemotherapy. This treatment is often an option for patients who have a tumor recurrence after previous brain cancer treatments.
Next topic: What are the facts about brain cancer?