View a list of resources dedicated to supporting your journey with cancer.
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
Indications:
GLIADEL® Wafer is indicated in patients with newly diagnosed high-grade
malignant glioma as an adjunct to surgery and radiation. GLIADEL is also indicated
in patients with recurrent glioblastoma multiforme as an adjunct to surgery.
Contraindication:
GLIADEL® Wafer should not be given to patients who have demonstrated
a previous hypersensitivity to carmustine or any of the components of GLIADEL.
Warnings:
Patients undergoing craniotomy for malignant glioma and implantation of GLIADEL
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, including one case leading to brain herniation.
Precautions:
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 obstructive hydrocephalus. If a communication larger than the diameter of
a wafer exists, it should be closed prior to wafer implantation.
Computed tomography and magnetic resonance imaging of the head may demonstrate enhancement
in the brain tissue surrounding the resection cavity after implantation of GLIADEL.
This enhancement may represent edema and inflammation caused by GLIADEL or tumor
progression.
The short-term and long-term toxicity profiles of GLIADEL when given in conjunction
with chemotherapy have not been fully explored.
Pregnancy and Nursing:
There are no studies assessing the reproductive toxicity of GLIADEL. Carmustine,
the active component of GLIADEL, can cause fetal harm when administered to a pregnant
woman.
It is recommended that patients receiving GLIADEL discontinue nursing.
Adverse Events:
Seizures:
In the initial surgery trial, the incidence of seizures was 33.3% in patients receiving
GLIADEL and 37.5% in patients receiving placebo. Grand mal seizures occurred in
5% of GLIADEL-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
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 and placebo. In this study, 12/22 (54%)
of patients treated with GLIADEL and 2/22 (9%) of placebo patients experienced the
first new or worsened seizure within the first five 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 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 and in 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 or its remnants.
Healing Abnormalities:
The following healing abnormalities have been reported in clinical trials of GLIADEL:
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-treated patients and in 11.7% of placebo recipients.
Cerebrospinal fluid leaks occurred in 5% of GLIADEL 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 the 14% of GLIADEL 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 and 6% in patients receiving placebo. In the recurrent
setting, the incidence of brain abscess or meningitis was 4% in patients treated
with GLIADEL and 1% in patients receiving placebo.
Please see the Prescribing Information for more information.
|
|
|
This website is intended for U.S. residents only.