Brain and Spinal Cord Tumors in Adults

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Treating Brain/CNS Tumors In Adults TOPICS

Treating specific types of adult brain and spinal cord tumors

The treatment options for brain and spinal cord tumors depend on several factors, including the type and location of the tumor and how far it has grown or spread.

Non-infiltrating astrocytomas

These tumors include pilocytic astrocytomas, which most often occur in the cerebellum in young people, and subependymal giant cell astrocytomas (SEGAs), which are almost always seen in people with tuberous sclerosis. Many doctors consider these benign tumors because they tend to grow very slowly and rarely grow into (infiltrate) nearby tissues.

These astrocytomas can often be cured by surgery alone, but older patients are less likely to be cured. Radiation therapy may be given after surgery, particularly if the tumor is not removed completely, although many doctors will wait until there are signs the tumor has grown back before considering it. Even then, repeating surgery may be the first option.

The outlook is not as good if the tumor occurs in a place where it can’t be removed by surgery, such as in the hypothalamus or brain stem. In these cases, radiation therapy is usually the best option.

For SEGAs that can’t be removed completely with surgery, treatment with the drug everolimus (Afinitor) may shrink the tumor or slow its growth for some time, although it’s not clear if it can help people live longer.

Low-grade astrocytomas
(Infiltrating or diffuse astrocytomas)

The initial treatment is surgery to remove the tumor if it can be done, or biopsy to confirm the diagnosis if surgery is not feasible. These tumors are hard to cure by surgery because they often grow into (infiltrate) nearby normal brain tissue. Usually the surgeon will try to remove as much of the tumor as safely possible. If the surgeon can remove it all, the patient may be cured.

Radiation therapy may be given after surgery, especially if a lot of tumor remains. Younger adults whose tumors were small and not causing many symptoms may not be given radiation unless the tumor shows signs of growing again. (In some cases, a second surgery may be tried before giving radiation.) In people who are older or whose tumors are at higher risk of coming back for other reasons, radiation is more likely to be given after surgery. Chemotherapy may also be given after surgery in some cases. Some doctors use genetic tests of the tumor to help determine if radiation or chemotherapy should be given.

Radiation or chemotherapy may be used as the main treatment if surgery is not a good option for some reason.

Intermediate- and high-grade gliomas
(Glioblastomas, anaplastic astrocytomas, anaplastic oligodendrogliomas, anaplastic oligoastrocytomas)

Surgery is often the first treatment when it can be done, but these tumors are almost never cured with surgery. As much of the tumor is removed as is safely possible. Radiation therapy is then given in most cases. This may be given with or followed by chemotherapy if the person’s health allows. For some people who are in poor health or whose tumor cells have certain gene changes, chemo may be used instead of radiation therapy.

For tumors that can’t be treated with surgery, radiation therapy — with or without chemo — is usually the best option.

Temozolomide is the chemotherapy drug used first by most doctors because it crosses the blood-brain barrier and it’s convenient because it can be taken as a pill. It is sometimes given along with radiation therapy and then continued after the radiation is completed.

Cisplatin, carmustine (BCNU), and lomustine (CCNU) are other commonly used drugs. Combinations of drugs may also be used, such as the PCV regimen (procarbazine, CCNU, and vincristine). All of these treatments may shrink or slow tumor growth for some time, but they are very unlikely to cure the tumor.

If standard chemotherapy drugs are no longer effective, the targeted drug bevacizumab (Avastin) may be helpful for some people, either alone or with chemo.

In general, these tumors are very hard to control for long periods of time. Because these tumors are so hard to cure with current treatments, clinical trials of promising new treatments may be a good option.

Oligodendrogliomas

If possible, surgery is the first option for oligodendrogliomas. Surgery usually doesn’t cure these tumors, but it can relieve symptoms and prolong survival. Many oligodendrogliomas grow slowly, especially in younger people, and may not need further treatment right away. Surgery may be repeated if the tumor grows back in the same spot. Radiation therapy and/or chemo (most often with temozolomide or the PCV regimen) may also be options after surgery.

Oligodendrogliomas may respond to chemotherapy better than other brain tumors if the tumor cells have certain chromosome changes. You can ask your doctor about testing for these changes.

Radiation therapy or chemotherapy may be helpful for tumors that can’t be treated with surgery.

Ependymomas and anaplastic ependymomas

These tumors usually do not grow into nearby normal brain tissue. Sometimes, patients may be cured by surgery alone if the entire tumor can be removed, but often this is not possible. If only part of the tumor is removed with surgery (or if it is an anaplastic ependymoma), radiation therapy is given after surgery. If surgery cannot be done, radiation therapy is the main treatment.

Sometimes the tumor cells can spread into the cerebrospinal fluid (CSF). Patients typically get an MRI of the brain and spine (and possibly a lumbar puncture) a few weeks after surgery if it is done. If either of these tests shows that the cancer has spread through the CSF, radiation therapy is given to the entire brain and spinal cord.

Chemotherapy is usually not helpful for these tumors, so it is usually not given unless the tumor can no longer be treated with surgery or radiation.

Meningiomas

Most meningiomas tend to grow slowly, so small tumors that aren’t causing symptoms can often be watched rather than treated, particularly in the elderly.

If treatment is needed, these tumors can usually be cured if they are removed completely with surgery. Radiation therapy may be used along with, or instead of, surgery for tumors that can’t be removed completely. For meningiomas that are atypical or invasive (grade II) or anaplastic (grade III), which tend to recur after treatment, radiation therapy is typically given after surgery even if all of the tumor has been removed.

For meningiomas that recur after initial treatment, further surgery (if possible) or radiation therapy may be used. If surgery and radiation aren’t options, drug treatments (chemotherapy, immunotherapy, or hormone-like drugs) may be used, but it’s not clear how much benefit they offer.

Schwannomas (including acoustic neuromas)

These slow-growing tumors are usually benign and are cured by surgery. In some centers, small acoustic neuromas are treated by stereotactic radiosurgery (see the section “Radiation therapy for adult brain and spinal cord tumors”). For large schwannomas where complete removal is likely to cause problems, tumors may be operated on first to decrease their size and then the remainder is treated with radiosurgery.

Spinal cord tumors

If a spinal cord tumor is small and not causing symptoms, it might not need to be treated right away. Other spinal cord tumors are treated like those in the brain. Astrocytomas of the spinal cord usually cannot be removed completely. They may be treated with surgery to obtain a diagnosis and remove as much tumor as possible, and then by radiation therapy, or with radiation therapy alone. Meningiomas of the spinal canal are often cured by surgery, as are some ependymomas. If surgery doesn’t remove an ependymoma completely, radiation therapy is often given.

Lymphomas

Treatment of central nervous system lymphomas generally consists of chemotherapy and/or radiation therapy. Treatment is discussed in more detail in our document Non-Hodgkin Lymphoma.

Brain tumors that occur more often in children

Some types of brain tumors occur more often in children but do occur occasionally in adults. These include brain stem gliomas, germ cell tumors, craniopharyngiomas, choroid plexus tumors, medulloblastomas, primitive neuroectodermal tumors (PNETs), and some others. Treatment of these tumors is described in our document Brain and Spinal Cord Tumors in Children.


Last Medical Review: 03/05/2014
Last Revised: 03/05/2014