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

Non-infiltrating astrocytomas

These tumors include juvenile pilocytic astrocytomas, which most commonly occur in the cerebellum in young people, and the subependymal giant cell astrocytomas, which are almost always associated with tuberous sclerosis. Many doctors consider these to be benign tumors.

In most cases, these astrocytomas are cured by surgery alone. Older patients, though, are less likely to be cured. Radiation therapy may be given, particularly if the tumor is not completely removed, although many doctors will wait until there are signs the tumor has grown back before considering it. Even then, repeat surgery may be the first option. The outlook is not as good if the astrocytoma occurs in a place that does not allow it to be removed surgically, such as the hypothalamus or brain stem.

Low-grade astrocytomas (infiltrating or diffuse astrocytomas)

The main treatment for these tumors is surgery when possible. 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 is able to remove it all this may be curative.

Radiation therapy may be given after surgery, especially if large amounts of tumor remain. In younger patients, this may be postponed until the tumor shows signs of regrowth. (In some cases, a second surgery may be tried before giving radiation.) Some doctors may also consider giving chemotherapy after surgery.

Radiation or chemotherapy may also be used as the main treatment if surgery is not a good option because of tumor location.

Intermediate- and high-grade astrocytomas
(Anaplastic astrocytomas, glioblastoma multiforme)

Although surgery is often the first treatment when it can be done, these tumors are not curable by surgery. As much of the tumor as is safely possible is removed. Chemotherapy wafers may be placed in or near any remaining tumor at this time. Radiation therapy is then given, usually along with or followed by chemotherapy.

Temozolomide is the drug most commonly used to treat these tumors. It is often given along with radiation therapy, as it appears to make it more effective. It is then continued after the radiation is completed. Temozolomide is the drug used first by most doctors because it's a pill, is convenient to give, and has shown success in prolonging lives.

Cisplatin, carmustine (BCNU), and lomustine (CCNU) are other drugs commonly used. Combinations of drugs may also be used, such as the PCV regimen (procarbazine, CCNU, and vincristine). All of these treatments have had some success, but none is curative.

For tumors that cannot be treated with surgery, radiation therapy -- with or without chemotherapy -- is usually the best option.

In general, these tumors are very hard to treat effectively for extended 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 and anaplastic oligodendrogliomas

If possible, surgery is the first option for oligodendrogliomas. While they are usually not curable by surgery, it can relieve symptoms and prolong survival. Many oligodendrogliomas grow slowly, especially in younger people, and may not require further immediate treatment. Surgery may be repeated in many cases if it grows back in the same spot. Radiation therapy and/or chemotherapy (most often with temozolomide or the PCV regimen) may also be options after surgery, particularly in cases of anaplastic oligodendroglioma.

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

For tumors in which surgery is not an option, chemotherapy, with or without radiation therapy, may be helpful.

Anaplastic oligodendrogliomas tend to be more aggressive. They are treated the same way as anaplastic astrocytomas (see above).

Ependymomas and anaplastic ependymomas

These tumors usually do not infiltrate normal brain tissue. They may be cured in some cases by surgery alone if the entire tumor can be removed.But often this is not possible. In cases where these tumors can't be cured with surgery, radiation therapy is given after surgery. If imaging tests or a lumbar puncture show that the cancer may have reached the spinal cord, the radiation may be extended to include the spinal cord.

The use of chemotherapy after surgery is still being tested in clinical trials. It may be recommended, although its benefit is still uncertain. It may be more helpful if the tumor is an anaplastic ependymoma.

Meningiomas

These tumors can usually be cured if completely removed surgically. Some tumors, particularly those at the base of the brain, cannot be completely removed, and a few are malignant and recur despite apparent complete removal. Radiation therapy may be used along with, or instead of, surgery for tumors that can't be completely removed. It may also be used to try to control regrowth of meningiomas that recur after surgery. Chemotherapy or hormonal drugs may be tried if surgery and radiation aren't effective, but it's not clear if they offer any benefit.

Because of their slow growth, small or asymptomatic meningiomas can often be watched rather than treated, particularly in the elderly.

Schwannomas (including acoustic neuromas)

These slow growing tumors are usually benign and are cured by surgical removal. In some centers, small acoustic neuromas are treated by stereotactic radiosurgery (see the section on Radiotherapy above). In cases of large schwannomas where complete removal is likely to cause problems, tumors may be operated on first to decrease their size and then have the remainder treated with radiosurgery. For the rare malignant schwannomas, radiation therapy is often given after surgery.

Spinal cord tumors

These tumors are treated in a manner similar to those in the brain. Astrocytomas of the spinal cord usually cannot be completely removed. They may be treated with surgery to remove as much tumor as possible, followed by radiation therapy, or with radiation therapy alone. Meningiomas of the spinal canal are often cured by surgical removal, as are some ependymomas. If surgery doesn't completely remove an ependymoma, radiation therapy is often given.

Lymphomas

Treatment of CNS lymphomas is discussed in our document, Non-Hodgkin Lymphoma.

Brain tumors that occur more often in children

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

Survival rates for selected brain and spinal cord tumors

The numbers below come from the Central Brain Tumor Registry of the United States (CBTRUS) and are based on people who were treated between 1973 and 2002. There are some important points to note about these numbers:

• The 5-year survival rate refers to the percentage of patients who live at least 5 years after being diagnosed. Many of these patients live much longer than 5 years after diagnosis. Five-year relative survival rates (such as the numbers below) don't include patients who die from other causes. They are considered to be a more accurate way to describe the outlook for patients with a particular type of cancer.

• Survival rates for brain and spinal cord tumors vary widely by age, with younger people generally having better outlooks than older people (as can be seen in the numbers below). The survival rates for those 65 or older are generally lower than the rates for the ages listed below.

• While these numbers are among the most current we have available, they represent people who were first diagnosed and treated many years ago. Improvements in treatment since then mean that the survival rates for those now being diagnosed with these cancers may be higher.

• These numbers are for some of the more common types of malignant brain and spinal cord tumors. Numbers are not readily available for all types of tumors, often because they are rare or are hard to classify.

• Survival statistics can sometimes be useful as a general guide, but they may not accurately represent any one person's prognosis. A number of other factors, including the size and location of the tumor and the amount that can be removed by surgery, can also affect outlook. Your doctor is likely to be a good source as to how well these numbers may apply to you, as he or she is familiar with the aspects of your particular situation.