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Types of Brain Tumor Treatment
The treatment for a primary brain tumor depends on its type, location and size.
The main types of treatment are surgery, radiation, chemotherapy and/or a combination
of these.
Surgery1,2
Surgery is the standard treatment for brain tumors. The most common type of surgery
performed to remove brain tumor is a craniotomy, a section of bone (bone flap) is
removed from the skull so that the underlying tissue can be accessed for operation.
The bone flap is replaced at the end of the procedure. Whenever possible, the surgeon
tries to remove the entire tumor. If the tumor cannot be completely removed without
damaging vital areas of the brain, the surgeon will take out as much of the tumor
as possible. The rest of the tumor can be treated with radiation and/or chemotherapy.
Since it is virtually impossible to remove all of the microscopic cells while operating
in the brain, surgery alone may not be enough to remove every cancer cell.
After surgery, you may receive steroids to help reduce swelling, antiepileptic medications
to control seizures, and antibiotics to fight infection. For more detailed information
on medications, consult with your doctor. You and your doctor can determine what
treatment is right for you.
Radiation3,4
Radiation is an energy beam that is directed at the tumor to stop or slow its growth.
It does this by damaging the cells — both normal cells and cancer cells — in the
path of its radiation exposure. Because cancer cells are less organized than normal
cells, they are more easily destroyed by radiation; normal cells can repair themselves
and survive. Radiation can be used in several different ways to fight tumors. If
your treatment plan involves radiation therapy, you and your doctor will talk about
which method is best for you.
Chemotherapy4,5
Chemotherapy is the use of drugs to kill tumor cells. Most drugs used to treat brain
tumors are given by mouth or injected into your vein (called intravenous or I.V.).
Many of the side effects of chemotherapy are caused by the drug’s effects on healthy
body tissues, as well as on the tumor.
Carmustine is one of the most common I.V. chemotherapy agents used to treat primary
brain tumors. It can be useful in treating brain tumors like GBM.
Delivery of GLIADEL® Wafer6
GLIADEL® Wafer is the only FDA approved chemotherapeutic implant
for use during neurosurgical resection.
GLIADEL® Wafer are small, dime-sized biodegradable polymer wafers
that are designed to deliver BCNU or carmustine directly into the surgical cavity
created when a brain tumor is resected. After a neurosurgeon operates to remove
the high-grade malignant glioma, he or she may implant up to 8 GLIADEL®
Wafers depending on the size of surgical cavity.
References
Prescribing Information
Important Safety Information
GLIADEL Wafer should not be given to patients who have demonstrated a previous hypersensitivity
to carmustine or any of the components of GLIADEL Wafer.
Patients undergoing craniotomy for malignant glioma and implantation of GLIADEL
Wafer should be monitored closely for known complications of craniotomy, including
seizures, intracranial infections, abnormal wound healing, and brain edema. Cases
of intracerebral mass effect unresponsive to corticosteroids have been described
in patients treated with GLIADEL Wafer, including 1 case leading to brain herniation.
Carmustine, the active component of GLIADELWafer, can cause fetal harm when administered
to a pregnant woman. It is recommended that patients receiving GLIADEL Wafer discontinue
nursing.
Communication between the surgical resection cavity and the ventricular system should
be avoided to prevent the wafers from migrating into the ventricular system and
causing obstructivehydrocephalus. If a communication larger than the diameter of
a wafer exists, it should be closed prior to wafer implantation.
CT and MRI of the head may demonstrate enhancement in the brain tissue surrounding
the resection cavity after implantation of GLIADEL Wafer. This enhancement may represent
edema and inflammation caused by GLIADEL Wafer or tumor progression.
The short-term and long-term toxicity profiles of GLIADEL Wafer when given in conjunction
with chemotherapy have not been fully explored.
The following 4 categories of adverse events are possibly related to treatment with
GLIADEL Wafer:
Seizures: In the initial surgery trial, the incidence of seizures was 33.3%
in patients receiving GLIADEL Wafer and 37.5% in patients receiving placebo. Grand
mal seizures occurred in 5% of GLIADEL Wafer–treated patients and 4.2% of placebo-treated
patients. The incidence of seizures within the first 5 days after wafer implantation
was 2.5% in the GLIADEL Wafer group and 4.2% in the placebo group.
In the surgery for recurrent disease trial, the incidence of post-operative seizures
was 19% in both patients receiving GLIADEL Wafer and placebo. In this study, 12/22
(54%) of patients treated with GLIADEL Wafer and 2/22 (9%) of placebo patients experienced
the first new or worsened seizure within the first 5 post-operative days.
The median time to onset of the first new or worsened post-operative seizure was
3.5 days in patients treated with GLIADEL Wafer and 61 days in placebo patients.
Brain Edema: In the initial surgery trial, brain edema was noted in 22.5%
of patients treated with GLIADEL Wafer and 19.2% of patients treated with placebo.
Development of brain edema with mass effect (due to tumor recurrences, intracranial
infection, or necrosis) may necessitate re-operation and, in some cases, removal
of GLIADEL Wafer or its remnants.
Healing Abnormalities: The following healing abnormalities have been reported
in GLIADEL Wafer clinical trials: wound dehiscence, delayed wound healing, subdural,
subgaleal or wound effusions, and cerebrospinal fluid leak. In the initial surgery
trial, healing abnormalities occurred in 15.8% of GLIADEL Wafer–treated patients
and in 11.7% of placebo recipients. Cerebrospinal fluid leaks occurred in 5% of
GLIADEL Wafer recipients and 0.8% of those given placebo.
During surgery, a water-tight dural closure should be obtained to minimize the risk
of cerebrospinal fluid leak. In the surgery for recurrent disease trial, the incidence
of healing abnormalities was 14% in GLIADEL Wafer–treated patients and 5% in patients
receiving placebo wafers.
Intracranial Infection: In the initial surgery trial, the incidence of brain
abscess or meningitis was 5% in patients treated with GLIADEL Wafer and 6% in patients
receiving placebo. In the recurrent setting, the incidence of brain abscess or meningitis
was 4% in GLIADEL Wafer patients and 1% in patients receiving placebo.
Please see full Prescribing Information.
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