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Treatments for Brain and Spinal Tumors

We offer the most advanced treatment options

Once the diagnosis of a brain or spinal tumor is made, patients and families can be faced with many difficult decisions to make about their treatment options. Factors to consider include the extent of resection (how much of the tumor is removed at surgery), type of tumor and status of important markers like chromosomes or enzymes such as IDH or MGMT, the patient's ability to function and age.

Individualized treatment

The most important factor in determining a treatment course is the patient's wishes and willingness to accept different levels of side effects in order to benefit from the treatment. Your care team's job is to fully describe treatment options, including the risks and benefits of each. When they recommend a treatment, they will listen to you, respect your decisions and walk the journey with you.

Before recommending treatments, we will review records of medical care you have previously received from any care provider. This includes MRI scans, treatment history and a full pathology report, which may lead to a request for our neuropathologist to provide a second opinion of the tumor specimen.

This allows us to present the full range of appropriate treatment options for you. Our tumor board, which includes specialists from neurosurgery, neuropathology, radiation oncology and neuro-oncology, will discuss your MRI scans and pathology findings to make recommendations for treatment.

Neurosurgery

Even in the best circumstances, any tumor can be hard to treat. Surgery requires great emotional commitment and time to recover before additional treatments can begin. However, surgery is the single best way to quickly and effectively decrease the number of tumor cells in the body. It also potentially removes the bulky tumor that gets only limited blood flow and, if left in place, would allow tumor cells to hide from radiation and chemotherapy.

Both radiation therapy and chemotherapies work better if we are treating microscopic tumor cells versus a large tumor. These therapies work less well if we try to shrink a large tumor mass. Other factors that can make a tumor more difficult to treat include limited blood flow to the tumor, tumor cells resting in low-oxygen/low-nutritional environments in the center of the tumor, and a limited ability for chemotherapies to reach all parts of the tumor.

Most important, in addition to providing you the best outcome, your surgical team will discuss with you approaches to minimize the risk of your surgery.

While surgical risk can never be zero, a skilled and appropriately aggressive neurosurgeon who is equipped with advanced surgical tools can make surgeries as safe as possible.


Specialized mapping tools

The University of Kansas Hospital offers advanced techniques and technologies to remove all or as much of the tumor as safely as possible. These include:

  • 3D navigation
    Used during neurosurgery, 3D navigation allows surgeons to precisely pinpoint a location within the brain in all three planes (axial, coronal and sagittal). The surgeon can use this throughout the procedure as a map to highlight where the tumor ends and normal brain tissue begins.
  • Functional MRI brain mapping
    When appropriate, we offer functional MRI brain mapping, a technique that allows surgeons to locate specific areas of the brain before surgery so they can determine the best approach to the tumor. The technique helps surgeons avoid critical areas of the brain that control movement, speech and other functions.
  • Awake craniotomy
    In some cases, a craniotomy can be performed while the patient is awake. The patient is awakened from anesthesia after the initial incision is made. The patient is then asked to perform tasks while the surgeon operates close to a critical area.

Minimally invasive neurosurgery for brain tumors

For some patients, minimally invasive neurosurgery techniques can be considered to treat brain tumors. The neurosurgeon uses an endoscope (a thin tube with a light and camera at the end) to access areas of the brain that are difficult to reach. There are two types of minimally invasive endoscopic procedures:

  • Transventricular endoscopic surgery
    The surgeon guides the endoscope into the ventricular system, which consists of multiple spaces in the brain that are filled with spinal fluid. This procedure can be used to treat hydrocephalus (a buildup of fluid in the brain ventricles), remove certain cysts (like colloid cysts and arachnoid cysts) and remove certain intraventricular tumors.
  • Endonasal endoscopic brain surgery
    The surgeon guides the endoscope through the nose to perform surgery at the skull base. This can be done for pituitary adenoma, certain skull base meningiomas, chordomas, craniopharyngiomas and some malignant tumors, such as esthesioneuroblastoma.

The advantages of endoscopy include lower infection rate, faster recovery and less damage to normal brain tissue.

Radiation oncology

A radiation oncologist has spent years studying the delivery of radiation for the treatment of tumors, including cancers. While there are a number of different types of radiation, the goal is to damage the tumor cells while sparing surrounding healthy tissue as much as possible.

Delivery of radiation has improved greatly over the years to allow treatment focused on very precise locations. Many primary and metastatic brain and spine tumors can be effectively treated with radiation to either stop growth or reduce the chance of recurrence. Your radiation oncologist will discuss specific treatment details with you, as well as strategies to minimize side effects.

  • Stereotactic radiosurgery (SRS)
    This specialized form of radiation delivers a very high dose of radiation to a very precise area in only one or a few treatment sessions. It can very effectively kill tumor cells in the target area and is often used in treatment of metastatic tumors. In addition to SRS equipment such as the Gamma Knife and Cyber Knife, we offer advanced Novalis Tx™ image-guided radiosurgery. We are the region's only hospital to offer this advanced, noninvasive treatment for all types of brain tumors.

Neuro-oncologists

Neuro-oncologists are the principle coordinating physicians for cancer care. Neuro-oncologists provide ongoing care and management for brain and spine tumors, and work closely with others from neuroradiology, neurosurgery, neuropathology and radiation oncology. This physician will discuss the progress of your care plan, especially if there are changes, with the rest of the treatment team, often at regular tumor board meetings.

The goal of your neuro-oncologist is to maintain the best quality of life for you and support your family, during the course of treatment, as well as after treatment completion. Depending on your condition, your neuro-oncologist may provide treatments that include:

  • Chemotherapy
    The most commonly used treatment these specialists offer is chemotherapy, which can refer to any medication used to treat cancer. Chemotherapy may be in the form of pills (oral) or infusions (IV).

    These therapies are relatively nonspecific, which means they can affect cancer cells as well as normal body cells. Unlike surgery or radiation, the advantage of chemotherapy is that it can go almost anywhere in the body to attack cancer cells wherever they may be, even microscopic tumor deposits that can't be seen with MRI. However, this is also the disadvantage of chemotherapy as it cannot be centralized to only cancer cells.

  • Targeted therapies
    Targeted therapies entered clinical trials in the past decade. Because this type of therapy targets only specific cells, it delivers a greater impact to the tissue with high levels of these cells while sparing healthy tissue that has low levels or none of these cells. These therapies are currently under investigation as we continue to understand how best to use them alone and in combination.

  • Immunotherapies
    Historically, significant clinical testing of immunotherapies has provided limited benefits. However, more recently, this area of cancer medicine has made a resurgence. This is due to increased understanding of the immune system's anti-cancer effect, as well as tumor-caused suppression of the immune system. Generally, immunotherapy works to teach the immune system to recognize the markers on tumor cells as targets and attack the tumor in a sustained way. The idea is that this will offer a safe, effective and long-lasting effect. A number of different approaches are currently under investigation in clinical trials.

  • Devices
    FDA-approved therapeutic transmissible fields technology (Novo-TTF) is available at The University of Kansas Cancer Center. This technology is based on the observation that cell division can be stopped by exposing cancer cells to an alternating electric field. In glioblastoma, the device has been as effective as chemotherapy given at recurrence, but without significant chemotherapy side effects. Ongoing clinical trials seek to better understand how to use this technology alone or in combination with other approaches.

  • Additional neuro-oncology care/supportive care
    In addition to cancer treatment, your neuro-oncologist will help you manage your seizure medicine or, if needed, recommend a seizure specialist. Other areas of supportive care can include management of corticosteroids like dexamethasone, treatment of depression and helping to control other symptoms potentially affecting your quality of life.

    Studies have shown that good control of symptoms such as pain not only improves day-to-day enjoyment of life but can improve survival. Our neuro-oncologists are focused on supporting all patients and their families in getting the best outcomes and quality of life throughout the cancer journey.