Editing Brain tumor (section)

==Treatment==
A medical team generally assesses the treatment options and presents them to the person affected and their family. Various types of treatment are available depending on tumor type and location, and may be combined to produce the best chances of survival:<ref name="aans"/>
* Surgery:<ref name="aans"/> complete or partial [[Resection (surgery)|resection]] of the tumor with the objective of removing as many tumor cells as possible.
* Radiotherapy:<ref name="aans"/> the most commonly used treatment for brain tumors; the tumor is irradiated with beta, x rays or gamma rays.
* Chemotherapy:<ref name="aans"/> a treatment option for cancer, however, it is not always used to treat brain tumors as the blood–brain barrier can prevent some drugs from reaching the cancerous cells.
* A variety of experimental therapies are available through clinical trials.<ref>{{cite journal |last1=Huang |first1=Rui |last2=Boltze |first2=Johannes |last3=Li |first3=Shen |title=Strategies for Improved Intra-arterial Treatments Targeting Brain Tumors: a Systematic Review |journal=Frontiers in Oncology |date=26 August 2020 |volume=10 |page=1443 |doi=10.3389/fonc.2020.01443 |doi-access=free |pmid=32983974 |pmc=7479245 }}</ref><ref>{{cite journal |last1=Uluc |first1=Kutluay |last2=Neuwelt |first2=Edward A. |last3=Ambady |first3=Prakash |title=Advances in Intraarterial Chemotherapy Delivery Strategies and Blood-Brain Barrier Disruption |journal=Neurosurgery Clinics of North America |date=April 2022 |volume=33 |issue=2 |pages=219–223 |doi=10.1016/j.nec.2022.01.001 |pmid=35346454 }}</ref>

Survival rates in primary brain tumors depend on the type of tumor, age, functional status of the patient, the extent of surgical removal and other factors specific to each case.<ref>{{cite journal | vauthors = Nicolato A, Gerosa MA, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A | title = Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients | journal = Surgical Neurology | volume = 44 | issue = 3 | pages = 208–21; discussion 221–3 | date = September 1995 | pmid = 8545771 | doi = 10.1016/0090-3019(95)00184-0 }}</ref>

Standard care for anaplastic oligodendrogliomas and anaplastic oligoastrocytomas is surgery followed by radiotherapy. One study found a survival benefit for the addition of chemotherapy to radiotherapy after surgery, compared with radiotherapy alone.<ref>{{cite journal | vauthors = Lecavalier-Barsoum M, Quon H, Abdulkarim B | title = Adjuvant treatment of anaplastic oligodendrogliomas and oligoastrocytomas | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD007104 | date = May 2014 | volume = 2014 | pmid = 24833028 | doi = 10.1002/14651858.cd007104.pub2 | pmc = 7388823 }}</ref>

===Surgery===
Surgical resection of the greatest extent of contrast enhancing tumor possible (gross total resection) is associated with increased overall and progression free survival in those with glioblastoma. Gross total resection is often required in other brain tumors.<ref name="Schaff 2023" /> Minimally invasive techniques are becoming the dominant trend in neurosurgical oncology.<ref>{{cite journal | vauthors = Spetzler RF, Sanai N | title = The quiet revolution: retractorless surgery for complex vascular and skull base lesions | journal = Journal of Neurosurgery | volume = 116 | issue = 2 | pages = 291–300 | date = February 2012 | pmid = 21981642 | doi = 10.3171/2011.8.JNS101896 | doi-access = free }}</ref> The main objective of surgery is to remove as many tumor cells as possible, with complete removal being the best outcome and [[cytoreduction]] ("debulking") of the tumor may otherwise be done. Due to the infiltrative nature of glioblastomas, total resection is usually unachievable and progression after surgery usually occurs, with progression occurring about 7 months after surgery.<ref name="Schaff 2023" />

Many [[meningiomas]], with the exception of some tumors located at the skull base, can be successfully removed surgically.
Most [[pituitary adenoma]]s can be removed surgically, often using a minimally invasive approach through the [[nasal cavity]] and skull base (trans-nasal, trans-sphenoidal approach). Large [[pituitary adenoma]]s require a [[craniotomy]] (opening of the skull) for their removal. Radiotherapy, including [[stereotactic]] approaches, is reserved for inoperable cases.<ref>{{cite journal | vauthors = Gheorghiu ML, Fleseriu M | title = Stereotactic Radiation Therapy in Pituitary Adenomas, is it Better than Conventional Radiation Therapy? | journal = Acta Endocrinologica | volume = 13 | issue = 4 | pages = 476–490 | date = 2017 | pmid = 31149219 | pmc = 6516550 | doi = 10.4183/aeb.2017.476 }}</ref>

Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors.<ref>{{cite journal |last1=Penoncello |first1=Gregory P. |last2=Gagneur |first2=Justin D. |last3=Vora |first3=Sujay A. |last4=Yu |first4=Nathan Y. |last5=Fatyga |first5=Mirek |last6=Mrugala |first6=Maciej M. |last7=Bendok |first7=Bernard R. |last8=Rong |first8=Yi |title=Comprehensive Commissioning and Clinical Implementation of GammaTiles STaRT for Intracranial Brain Cancer |journal=Advances in Radiation Oncology |date=July 2022 |volume=7 |issue=4 |pages=100910 |doi=10.1016/j.adro.2022.100910 |pmid=35434425 |pmc=9010698 |s2cid=246623373 }}</ref><ref name="pmid11150363">{{cite journal | vauthors = DeAngelis LM | title = Brain tumors | journal = The New England Journal of Medicine | volume = 344 | issue = 2 | pages = 114–23 | date = January 2001 | pmid = 11150363 | doi = 10.1056/NEJM200101113440207 | issn = 0028-4793}}</ref>

Multiple metastatic tumors are generally treated with radiotherapy and chemotherapy rather than surgery and the prognosis in such cases is determined by the primary tumor, and is generally poor.{{Citation needed|date=October 2024}}

===Radiation therapy===
The goal of radiation therapy is to kill tumor cells while leaving normal brain tissue unharmed. In standard [[external beam radiation therapy]], multiple treatments of standard-dose "fractions" of radiation are applied to the brain. This process is repeated for a total of 10 to 30 treatments, depending on the type of tumor. This additional treatment provides some patients with improved outcomes and longer survival rates.{{citation needed|date=December 2020}}

[[Radiosurgery]] is a treatment method that uses computerized calculations to focus radiation at the site of the tumor while minimizing the radiation dose to the surrounding brain. Radiosurgery may be an adjunct to other treatments, or it may represent the primary treatment technique for some tumors. Forms used include [[stereotactic]] radiosurgery, such as [[Gamma knife]], [[Cyberknife (device)|Cyberknife]] or [[Novalis radiosurgery|Novalis Tx]] [[radiosurgery]].<ref>{{cite web |url=http://www.sdcyberknife.com/comparison.htm |title=Radiosurgery treatment comparisons – Cyberknife, Gamma knife, Novalis Tx |access-date=22 July 2014 |url-status=dead |archive-url=https://web.archive.org/web/20070520230154/http://www.sdcyberknife.com/comparison.htm |archive-date=20 May 2007  }}</ref>{{medrs|date=July 2014}}

[[Radiation therapy|Radiotherapy]] is the most common treatment for secondary brain tumors. The amount of radiotherapy depends on the size of the area of the brain affected by cancer. Conventional external beam "whole-brain radiotherapy treatment" (WBRT) or "whole-brain irradiation" may be suggested if there is a risk that other secondary tumors will develop in the future.<ref>{{cite web |publisher=Cancer Research UK |url=http://www.cancerhelp.org.uk/help/default.asp?page=5301 |title=Treating secondary brain tumours with WBRT |access-date=5 June 2012 |url-status=live |archive-url=https://web.archive.org/web/20071025211917/http://www.cancerhelp.org.uk/help/default.asp?page=5301 |archive-date=25 October 2007  }}</ref> Stereotactic radiotherapy is usually recommended in cases involving fewer than three small secondary brain tumors. Radiotherapy may be used following, or in some cases in place of, resection of the tumor. Forms of radiotherapy used for brain cancer include [[external beam radiation therapy]], the most common, and [[brachytherapy]] and [[proton therapy]], the last especially used for children.

People who receive stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT) for the treatment of metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone.<ref>{{cite web |publisher=MD Anderson Cancer Center |url=http://www.mdanderson.org/diseases/braincancer/display.cfm?id=8f11775f-75bb-4d7b-b3ac46878a1d56d0&method=displayfull&pn=00c8a30f-c468-11d4-80fb00508b603a14 |title=Whole Brain Radiation increases risk of learning and memory problems in cancer patients with brain metastases |access-date=5 June 2012 |url-status=dead |archive-url=https://web.archive.org/web/20081005220401/http://www.mdanderson.org/diseases/braincancer/display.cfm?id=8f11775f-75bb-4d7b-b3ac46878a1d56d0&method=displayfull&pn=00c8a30f-c468-11d4-80fb00508b603a14 |archive-date=5 October 2008  }}</ref><ref>{{cite web |publisher=International RadioSurgery Association |url=http://www.irsa.org/metastatic_tumors.html |title=Metastatic brain tumors |access-date=5 June 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120616155755/http://www.irsa.org/metastatic_tumors.html |archive-date=16 June 2012 }}</ref> Results of a 2021 systematic review found that when using SRS as the initial treatment, survival or death related to brain metastasis was not greater than alone versus SRS with WBRT.<ref>{{cite book | vauthors = Garsa A, Jang JK, Baxi S, Chen C, Akinniranye O, Hall O, Larkin J, Motala A, Newberry S, Hempel S | title = Radiation Therapy for Brain Metasases | date = 2021-06-09 | pmid = 34152714 | doi = 10.23970/ahrqepccer242 | s2cid = 236256085 }}</ref>

Postoperative conventional daily radiotherapy improves survival for adults with good functional well-being and high grade glioma compared to no postoperative radiotherapy. Hypofractionated radiation therapy has similar efficacy for survival as compared to conventional radiotherapy, particularly for individuals aged 60 and older with [[glioblastoma]].<ref>{{cite journal | vauthors = Khan L, Soliman H, Sahgal A, Perry J, Xu W, Tsao MN | title = External beam radiation dose escalation for high grade glioma | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 8 | pages = CD011475 | date = May 2020 | pmid = 32437039 | pmc = 7389526 | doi = 10.1002/14651858.CD011475.pub3 }}</ref>

===Chemotherapy===
Patients undergoing [[chemotherapy]] are administered drugs designed to kill [[tumor]] cells.<ref name="aans"/> Although chemotherapy may improve overall survival in patients with the most malignant primary brain tumors, it does so in only about 20 percent of patients. Chemotherapy is often used in young children instead of radiation, as radiation may have negative effects on the developing brain. The decision to prescribe this treatment is based on a patient's overall health, type of tumor, and extent of cancer. The toxicity and many side effects of the drugs, and the uncertain outcome of chemotherapy in brain tumors puts this treatment further down the line of treatment options with surgery and radiation therapy preferred.<ref>{{cite journal | vauthors = Perkins A, Liu G | title = Primary Brain Tumors in Adults: Diagnosis and Treatment | journal = American Family Physician | volume = 93 | issue = 3 | pages = 211–217 | date = February 2016 | pmid = 26926614 }}</ref>

UCLA Neuro-Oncology publishes real-time survival data for patients with a diagnosis of glioblastoma. They are the only institution in the United States that displays how brain tumor patients are performing on current therapies. They also show a listing of chemotherapy agents used to treat high-grade glioma tumors.<ref>{{cite web |publisher=UCLA Neuro-Oncology Program |url=http://www.neurooncology.ucla.edu/Performance/GlioblastomaMultiforme.aspx |title=How Our Patients Perform: Glioblastoma Multiforme |access-date=5 June 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120609070823/http://www.neurooncology.ucla.edu/Performance/GlioblastomaMultiforme.aspx |archive-date=9 June 2012  }}</ref>

Genetic mutations have significant effects on the effectiveness of chemotherapy. Gliomas with [[IDH1]] or [[IDH2]] mutations respond better to chemotherapy than those without the mutation. Loss of chromosome arms 1p and 19q also indicate better response to chemoradiation.<ref name=":4" />

===Other===
A [[Shunt (medical)|shunt]] may be used to relieve symptoms caused by [[intracranial pressure]], by reducing the build-up of fluid ([[hydrocephalus]]) caused by the blockage of the free flow of [[cerebrospinal fluid]].<ref>{{cite web | vauthors = Dalvi A |url= http://www.emedicinehealth.com/normal_pressure_hydrocephalus/page9_em.htm |title=Normal Pressure Hydrocephalus Causes, Symptoms, Treatment |work=eMedicineHealth |publisher=Emedicinehealth.com |access-date=17 February 2012 |url-status=live |archive-url=https://web.archive.org/web/20120222023351/http://www.emedicinehealth.com/normal_pressure_hydrocephalus/page9_em.htm |archive-date=22 February 2012  }}</ref>

For those with brain tumors, anti-seizure prophylactic (preventative) medications are not usually recommended. However, anti-epileptics are used in those with seizures.<ref name="Schaff 2023" />

Cerebral edema secondary to brain tumors is managed by corticosteroids. Dexamethasone is the preferred corticosteroid due to its long half life and reduced effect on water retention (mineralcorticoid activity). [[Bevacizumab]] (an anti-VEGFA antibody) may improve cerebral edema in those that are unresponsive to steroids.<ref name="Schaff 2023" />