Treatment for glioma depends on the type, size, grade and location of the tumor, as well as your age, overall health and preferences.
In addition to actions to remove the tumor itself, treatment for glioma may also require using drugs to reduce the signs and symptoms of your tumor.
Your doctor may prescribe steroids to reduce swelling and relieve pressure on affected areas of the brain. Anti-epileptic drugs may be used to control seizures.
Surgery to remove as much of the tumor as possible is usually the first step in treating most types of gliomas.
In some cases, gliomas are small and easy to separate from surrounding healthy brain tissue, which makes complete surgical removal possible. In other cases, tumors can't be separated from surrounding tissue, or they're located near sensitive areas in your brain and make surgery risky. In these situations your doctor removes as much of the tumor as is safe.
Even removing a portion of the tumor may help reduce your signs and symptoms.
In some cases, neuropathologists may analyze tissue samples removed by a surgeon and report the results while surgery is underway. This information helps the surgeon decide how much tissue to remove.
A variety of surgical technologies and techniques may be used to assist the neurosurgeon in protecting as much healthy brain tissue as possible while removing the tumor, including computer–assisted brain surgery, awake brain surgery and intraoperative MRI. For example, during awake brain surgery, you may be asked to move a limb or tell a story during surgery to ensure the areas of the brain controlling those functions are not damaged.
Surgery to remove a glioma carries risks, such as infection and bleeding. Other risks may depend on the part of your brain in which your tumor is located. For instance, surgery on a tumor near nerves that connect to your eyes may carry a risk of vision loss.
Radiation therapy usually follows surgery in treatment of glioma, especially high-grade gliomas. Radiation uses high-energy beams, such as X-rays or protons, to kill tumor cells.
Radiation therapy for glioma comes from a machine outside your body (external beam radiation).
There are several types of external beam radiation currently used and under study for the treatment of glioma. The type of glioma you have, its grade and other prognostic factors are considered in determining the timing and type of radiation therapy you may receive.
Radiation therapy options include using computers to target the brain tumor (intensity-modulated radiation therapy), using protons rather than X-rays as the source of radiation (proton beam therapy) and stereotactic radiation therapy (radiosurgery).
Stereotactic radiosurgery is not surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn't particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.
There are different types of technology used in radiosurgery to deliver radiation to treat brain tumors, such as a Gamma Knife or linear accelerator (LINAC).
Side effects of radiation therapy depend on the type and dose of radiation you receive. Common side effects during or immediately following radiation include fatigue, headaches and scalp irritation.
Stereotactic radiosurgery system
Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken in pill form (orally) or injected into a vein (intravenously).
Chemotherapy is usually used in combination with radiation therapy to treat gliomas.
The chemotherapy drug used most often to treat gliomas is temozolomide (Temodar), which is taken as a pill.
Side effects of chemotherapy depend on the type and dose of drugs you receive. Common side effects include nausea and vomiting, headache, hair loss, fever, and weakness. Some side effects may be managed with medication.
Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
One targeted drug therapy used to treat a type of brain cancer called glioblastoma is bevacizumab (Avastin). This drug, given through a vein (intravenously), stops the formation of new blood vessels, cutting off blood supply to a tumor and killing the tumor cells.
Rehabilitation after treatment
Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Your doctor may refer you to services that can help, such as:
- Physical therapy can help you regain lost motor skills or muscle strength
- Occupational therapy can help you get back to your normal daily activities, including work, after a brain tumor or other illness
- Speech therapy with specialists in speech difficulties (speech pathologists) can help if you have difficulty speaking
- Tutoring for school-age children can help kids cope with changes in their memory and thinking after a brain tumor
Little research has been done on complementary and alternative brain tumor treatments. No alternative treatments have been proved to cure gliomas. However, complementary treatments may help you cope with your brain tumor and its treatment. Talk to your doctor about your options.
Some complementary treatments that may help you cope include:
- Music therapy
- Relaxation exercises