Therapy

The therapy depends on the exact location of the brain tumor and the type of growth. Therefore, the result of the brain biopsy (sampling) must be awaited. The surgical removal of a brain tumor is performed by neurosurgeons after an exact diagnosis has been made.

It is important to know the exact location of the tumor, the patient’s condition and symptoms in order to be optimally prepared for the operation. Depending on the size and localization, different access routes are chosen. There is the direct route, where the surgeon opens the skull with a special saw or introduces the instruments through a drill hole in the skull calotte.

This is called transcranial access. There is also the possibility, if the location of the tumor allows it, of removing the growth through the nose. Brain tumors can be removed as far as possible by the surgical procedure, but also only partially.

It is also possible that the neurosurgical treatment cannot be performed at all.The tumor is therefore inoperable and cannot be removed by a so-called partial brain amputation. This is particularly the case if the tumor is located directly in an area that houses important functions of the human body, which would be severely impaired or even destroyed by surgery. Since there is always the risk of removing healthy nerve tissue during such operations and thereby causing neurological disorders such as memory disorders, paralysis, speech disorders or gait insecurity, imaging procedures such as MRI and CT are often used during the operation.

For some brain tumors, navigated brain stimulation or intraoperative speech monitoring may also be useful. As a rule, surgery is the only necessary treatment for benign brain tumors. For tumors with an increased risk of relapse (i.e. WHO grade II and above), for tumors that have only been partially removed or for brain tumors that cannot be operated on, other methods are used.

The operation of a brain tumor can be useful or necessary for various reasons. A distinction must be made between different indications for the performance of an operation. For example, benign brain tumors can be cured by surgery.

Malignant brain tumors can rarely be cured with surgery. Nevertheless, surgery can improve the quality of life or prolong the life span. Surgery is also necessary in order to take samples for the determination of certain tumors.

Thus, some tumors can only be clearly identified under the microscope. The determination is important for the development of an individual therapy concept. An operation on a brain tumor is performed by specially trained neurosurgeons.

During the operation, the skull is opened and the way to the tumor is prepared with special tools. During this time, the affected patient is usually under general anesthesia. If certain regions of the brain have to be manipulated, sometimes only a local anaesthetic is used, so that important regions of the brain can be spared during the operation.

In both cases, the affected patient does not feel the operation. Radiation of tumors can be used before (neoadjuvant) and/or after (adjuvant) surgical removal as well as the sole treatment. The high-energy radiation from, for example, photons or electrons is used to inhibit the growth of tumor cells or to disrupt the cell division process.

Since sick tissue reacts more sensitively to radiation therapy than healthy tissue, it is mainly the tumor tissue that is destroyed. Radiation therapy can be administered from the outside as well as via certain radiation sources (e.g. radionuclides), which are placed directly in the tumor area of the brain. However, this can also lead to neurological deficits.

Radiation therapy is either fractionated, i.e. performed in several individual sessions, or applied as a one-time therapy. In this treatment, so-called cytostatic drugs are used to prevent the diseased tissue from dividing and to cause the tumor to die. This type of therapy takes advantage of the rapid ability of brain tumor cells to divide, since such cells react more sensitively to chemotherapy.

Unfortunately, healthy cells of the body, which also divide quickly, are also damaged. This can lead to certain side effects such as hair loss or blood count changes. Chemotherapy is often carried out in combination with radiotherapy.

This is then called radiochemotherapy. As side effects, the same neurological problems can occur as with surgical therapy. In this therapy, the drugs (cytostatics) are administered directly into the blood or for swallowing (orally) as capsules. Exactly which drugs are used depends on the type of brain tumor. Subsequently, some cytostatic drugs that are used for brain tumors are listed: Cisplatin, vincristine, fluoruracil (5-FU), irinotecan (CPT-11) and many others are used for treatment.