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, how far it has grown or spread, and a person's age and overall health.

Non-infiltrating astrocytomas

These tumors include pilocytic astrocytomas, which most often develop 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 tumors benign because they tend to grow very slowly and rarely grow into (infiltrate) nearby tissues.

These astrocytomas can often be cured if they can be removed completely by surgery, 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 targeted 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 infiltrating astrocytomas
(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 (most often with temozolomide or the PCV regimen – procarbazine, CCNU, and vincristine) may also be given after surgery in some cases. Some doctors use lab tests of the tumor to help determine if radiation or chemotherapy should be given.

Radiation and/or chemotherapy may be used as the main treatment if surgery is not a good option.

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 a person is healthy enough. For some people who are in poor health or whose tumor cells have certain gene changes found on lab tests, chemo may be used instead of radiation therapy.

For tumors that can’t be treated with surgery, radiation therapy along with 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, such as the PCV regimen (procarbazine, CCNU, and vincristine), may also be used. 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, Mvasi) may be helpful for some people, either alone or with chemo.

For glioblastomas, another treatment option might be alternating electrical field therapy with the Optune device. This can be used along with chemo (after surgery and radiation) as part of the initial treatment, or it can be used by itself (instead of chemo) for tumors that come back after treatment. 

In general, these gliomas 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.


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 - procarbazine CCNU, and vincristine,) may also be options after surgery.

Oligodendrogliomas tend to respond better to chemotherapy than some other brain tumors.

Radiation therapy and/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 spinal cord (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.


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 can be 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 come back after treatment, radiation therapy is typically given after surgery even if all of the visible 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 (such as 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 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 remove as much as is safe, 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.

Primary CNS lymphomas

Treatment of central nervous system (CNS) lymphomas generally consists of chemotherapy and/or radiation therapy. Treatment is discussed in more detail in 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 Brain and Spinal Cord Tumors in Children.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: September 30, 2017 Last Revised: November 8, 2017

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