Brain Tumors: Primary - Surgery

Highlights	Diagnosis	Resources
Introduction	Treatment	References
Causes	Surgery	Resources
Risk Factors	Radiation	References
Prognosis	Chemotherapy
Symptoms	Treatment of Complications

Radiation

Radiation therapy, also called radiotherapy, plays a central role in the treatment of most brain tumors.

Various radiation treatments are used. Radiation is usually given externally, from a source outside the body that directs radiation beams. In some cases, internal radiation may be used as a booster to external-beam radiation. Internal radiation (also called interstitial radiation) generally involves brachytherapy, which uses radioactive "seeds" implanted directly in the tumor site.

Radiotherapy after Surgery. Even when it appears that the entire tumor has been surgically removed, microscopic cancer cells often remain in the surrounding brain tissue. Radiation targets the residual tumor with the goal of reducing its size or stopping its progression. If the entire tumor cannot be removed safely, postoperative radiotherapy is often recommended. Even some benign gliomas may need radiation, since they may become life threatening if their growth is not controlled.

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Radiotherapy When Surgery Is Not Appropriate. Radiotherapy may be used instead of surgery for inaccessible tumors or for tumors that have properties that are particularly responsive to radiotherapy.

Radiotherapy and Chemotherapy (Radiochemotherapy). Combining chemotherapy with radiotherapy is beneficial for some patients with high-grade tumors.

Conventional Radiotherapy

Conventional radiotherapy uses external beams aimed directly at the tumor and is usually recommended for large or infiltrating tumors. It begins about a week after surgery and continues on an outpatient basis 5 days per week for 6 weeks. Older adults tend to have a more limited response to external-beam radiation therapy than younger people. Conventional external-beam radiation techniques include:

Three-dimensional conformal radiation therapy (3D-CRT) uses computer-generated imaging scans to map the tumor’s location. Radiation beams are then used that conform to the three-dimensional shape of the tumor.
Intensity-modulated radiation therapy (IMRT) is a more advanced and higher-dose form of 3D-CRT.
Conformalproton beam radiation therapy is also similar to 3D-CRT but uses proton beams instead of x-ray energy. It is not yet widely available.