What is Brain Cancer?
The brain, like any other tissue in the body, is made up of individual cells which are much smaller than a pinpoint, and require a microscope to see them. These cells are the smallest units which compose the brain, and there are several different types. A brain cancer can arise from any of the cells which make up the brain. Basically, the brain's thinking cells (called "neurons") are meant to divide rapidly before birth, and up until about 7 years old. At this time the brain is fully grown, and contains all the "neurons "that it ever will. Further development is by the existing cells making increasingly elaborate connections with each other, to communicate with one another.
Once the brain cells stop dividing in childhood, they are never meant to divide again.
If the brain is injured, such as by trauma or a stroke, specific cells within the
brain (the "glial cells" ) divide to form scar tissue, but the brain's thinking cells
(the neurons) don't reproduce (although damaged ones may be repaired). You can
see that the division of brain cells is under strict regulation and control. When
this
control is lost in a single cell, then it starts dividing in an uncontrolled manner. Brain
cancer starts in just one cell. As the cell makes more and more copies of itself,
it
grows to form a tumor (which means a swelling). A benign tumor stays where it starts,
although it can grow very large and press on crucial areas. In contrast, a malignant
tumor has a capacity to spread, and is then called "brain cancer". "Primary" brain
cancer starts within the brain,
and is the main subject of this transcript. In contrast, "secondary" brain cancer starts in some other organ (like lung or breast) and thenspreads to the brain. This is called "brain metastasis".
How common is brain cancer?
There are about 15,000 cases per year in the United States of "primary brain
cancer". This causes about 10,000 deaths per year. Thus primary brain cancers account
for 2% of the cancers yearly in the U.S.A. Much more common is brain Metastasis with at least 80,000 cases per year in the U.S.A. Since many cancers spread to the
brain, and it is a critical structure, this accounts for almost 20% of total cancer
deaths each year. While primary brain tumors account for 20% of the cancers in children, the majority of cases are in older individuals.
What causes or increases the risk for Brain Cancer?
Like any cancer, the exact reason why one person gets brain cancer and another
doesn't is unknown. However, several things have been found to increase the risk
of developing brain cancer:
1) Having rare family diseases, carried in the genes, such as Neurofibromatosis (the "Elephant Man" syndrome), Von-Hippel Lindau, Sturge-Weber's
or Turcot's syndrome. These all belong to a family of diseases
called the
"phacomacoses" and present with cysts or bumps on or inside the
body and high risk for brain tumors.
2) Exposure to certain chemicals, including chlorinated hydrocarbons (like PVC) and benzene, is associated
with a higher risk of brain cancers.
3) Exposure to radiation has also been connected to developing brain cancers
as well as other malignancies. The risk is greater if the person
is exposed
to at a young age to a higher dose. Pre-existing benign type tumors
may become cancerous (called "malignant degeneration) if radiated.
**Tobacco an Alcohol use have not been connected to brain cancers. They
are not contagious.
What are the Symptoms of Brain Cancer?
This depends upon where in the brain the cancer arises, and how big it becomes
before coming to medical attention. The brain has particular areas controlling thought,
sight, hearing, sensation, movement, coordination and mood. The upper brain area
tends to control the more advanced thought functions, while the middle controls mood
and movement and the rear (or "brain stem") stimulates breathing and heart rate.
The most common general symptoms of brain cancer are:
a) Seizures - any foreign body in the brain, including a tumor, can disturb it's normal electrical activity. The average brain runs on about 25 watts of electricity,
enough to power a small bulb. In chronic epilepsy, doctors look for an
abnormal
area of the brain, called a "focus", and see if it can be safely removed
to stop
the seizures. Likewise, if a person comes to the doctor with new onset
seizures,
the first thing to check for is an abnormal area, or tumor, in the brain.
b) Headaches - There is limited room inside the skull; the brain and it's linings are
insulated by a cushioning fluid that fills up the available space. If something
starts growing inside the skull, it quickly increases the pressure within
the skull.
This is called "increased intracranial pressure" or "ICP" for short. While
the brain
itself has no nerve endings, and sofeels no pain, the linings of the brain are rich
in sensory nerves and quickly detect an increase in pressure on them, causing
headache. Brain tumor headaches tend to be worse in the morning, upon awakening, and furthermore they get worse each day.
c) Nausea and Vomiting are also possible signs of increased pressure within
the brain, especially when accompanied by headache. The nausea is more common than actual vomiting.
d) Imbalance and stumbling can indicate a brain tumor, either because they are
a symptom of increased pressure within the skull or because the tumor presses
on the delicate areas controlling coordination, in the midbrain or cerebellum.
Some particular symptoms of brain cancer, depending on it's location:
e) Weakness in just one portion of the body, such as the right arm and leg or just
the left hand. Generalized weakness, or fatigue, is itself not suspicious
for brain
tumors. Specific areas of the brain "represent" and control the movement
and
sensation of each part of the body, and a tumor there will disrupt that
exact part.
This can localize a tumor to the "motor cortex" in the upper brain.
f) Sensation changes in a particular part of the body, for the above reason. Numbness or a burning sensation in a limb may localize a tumor to the "sensory
cortex" in the upper brain.
g) Visual problems - double vision is common and may occur from increased
pressure within the skull pressing on the nerves controlling the eyes
(especially number VI, called the abducens nerve which is the longest in the
skull).
Partial blindness can occur from pituitary tumors in the midbrain pressing
on
the optic nerves, or from tumors at the very back of the brain (occipital
lobe)
where the the "visual cortex", which controls sight, is located.
h)Judgment or personality changes occur especially with tumor located near
the front of the brain, in the "frontal cortex" which helps control
personality. The
changes typically get very obvious and don't improve with counseling.
i) Growth disturbance, breast enlargement, or changes in sex drive.
j) An insatiable desire to drink water, with frequent urination, is called
SIADH and
results from compressing of the midbrain structures controlling the body's
fluid
balance.
k) Hallucinations in vision or hearing arise from a tumor where these senses are
processed. This often involves seeing bright objects or hearing music.
What are the Types of Brain Tumors?
There are many types of brain tumors, since there are many types of cells in the brain
and each gives rise to specific tumors. The most common type of brain tumor in adults
isGlioma which is nearly 1/2 of all cases. Gliomas arise from the structural cells that hold
the brain together. Gliomas are further divided into particular types:
a) One-half of gliomas, or 1/4 of all brain tumors, are glioblastoma multiforme which is the most deadly and hard to treat brain cancer.
b)Astrocytomas make up 15% of brain tumors, and may either be low-grade,
which means indolent and curable, or higher grade, which are aggressive.
c) Other gliomas, at about 2% each, include ependymoma, which arises from
the cells which line inner cavities of the brain (called the ventricles),oligodendroglioma which comes from another structural cell, and medulloblastoma which is much more common in children. All these other glioma types
can be either indolent or aggressive, depending upon their grade,
and the
treatment are different for the various types.
The next most common brain tumor (15%) is the meningioma which arises from the cells that form lining between the surface of the brain and
the skull. Over 90% of these only grow locally, and so aren't true cancer, but cause
symptoms by pressing on the brain. About 8%, however, are malignant, and thus more
aggressive and can spread.
Pituitary (8%) andPineal (1%) tumors arise from the glands in the brain. They tend
to just grow larger and press on delicate structures, like the optic tracts controlling
vision, and may secrete hormones changing sex drive, growth, or thyroid function.
How are Brain Tumors Diagnosed and Evaluated?
A tumor simply means a swelling, and isn't necessarily cancer. A patient will
come to the doctor with symptoms suspicious for a brain tumor, and the physician
will perform a neurological examination to check the nerves or the brain which control the eyes and face, check for equal
strength and sensation on both sides of the body,
coordination and balance, and memory and judgment. He will look into the eyes for
signs of increased pressure in the skull, such as swelling of the optic disks.
The next step is to order a radiological test to look for the tumor. Most commonly
a CAT scan is gotten which an array of X-ray beams to visualize the brain. Often contrast material is injected into a vein during the CAT scan, as this highlight abnormal
areas in the brain. This test takes about 1/2 hour and the films are read by a radiologist. Large tumors are very easily seen on CAT scan, but ones smaller than 1 cm or
in the cerebellum may not be obvious.
If a tumor is seen, or there is still high suspicion of one, the next test
ordered is
a Magnetic Resonance Image (MRI) scan ; it doesn't use radiation and is very accurate for detecting even small brain tumors in the cerebellum. It takes about an hour
of lying still, is painless, and is much more expensive than a CAT scan, which is
why they only order it after confirming a tumor.
The only way to be absolutely sure of what kind of tumor is present is to take
a sample (biopsy) of it. Nowadays, biopsies are very safe (less than 1% of patients
die
from them) and are usually obtained under stereotactic guidance (a fine-needle is
exactly placed into the tumor after visualizing it in 3 dimensions). The biopsy material
is examined by a pathologist, a doctor who specializes in diagnosing disease from
tissue samples. He does special stains on it and examines it under a microscope to
see what type of tumor it is, and grades it depending upon how aggressive it looks.
Rarely, the type of tumor is so obvious from the scans or is so deep in the brain
that
a biopsy isn't gotten, the tumor is treated based upon whats it's presumed to be.
Other possible tests include an MRI of the spine for certain tumors (medulloblastoma and high grade ependymoma) which tend to seed down the spine, a spinal tap
to look for cancer cells shedding into the cerebral-spinal fluid that bathes the brain
and spinal cord, and an endocrine (hormonal) blood test evaluation for pituitary
or midbrain tumors. We may test to look for the origin of the tumor elsewhere in
the
body if it is believed not to have started in the brain. Spread of primary brain tumors
to other body organs is very rare, but when it occurs it's usually to lung or bone
marrow.
How is the Extensiveness of Brain Cancer Gauged?
Like any cancer, the extent of brain cancer is given by the"stage"- (it follows grade).
Stage I means the tumor is Low Grade
Stage II means the tumor is Low-Intermediate Grade
Stage III means the tumor is Intermediate Grade
Stage IV means the tumor is High Grade
Each stage is further divided into "A" and "B" with "B" being more extensive than
"A".
How Curable is Brain Cancer?
This depends upon the type of brain cancer, it's location, the stage, and
of course
the treatment selected. In general, with conventional treatment.
Type of cancer
5-year survival
10-year survival
glioma, optic nerve 80%
70%
glioma, low grade 70%
50%
glioma, intermediate grade 40%
20%
glioma, high grade (anaplastic) 15%
5%
glioblastoma multiforme (highest grade) 2%
0%
pituitary adenoma 90%
80%
craniopharyngioma 80%
70%
pinealoma 70%
60%
meningioma 70%
50%
oligoendroglioma 70%
30%
ependymoma 50%
40%
medulloblastoma 50%
40%
**Note that for deep tumors in the midbrain and brain stem, survival falls to about
30%
for even low grade gliomas. Also, 10 year survival is generally 10% less than 5 year
survival, except for gliomas, where it is 20% - 50% less.
It is important to realize that the newest treatments offer more hope than ever
before for many brain tumors. Specifics of the conventional treatment, and results,
including
surgery, radiation, and chemotherapy as well as the latest effective treatments are now discussed.
Brain Tumor Treatment
What is the Conventional Treatment of Brain Tumors?
Historically, treatment of brain tumors has used surgery, radiation treatment and/or
chemotherapy. Each of these has improved dramatically over the past decades.
Surgery Alone:
Surgery is the oldest treatment for brain cancer; there is evidence that it was done
on a primitive scale by the ancient Aztecs, and it's use continues to evolve today.
Surgery is curative for many benign and low-grade brain tumors. Techniques of surgery
have advanced dramatically in the past 2 decades, with routine use of operating microscopes,
lasers, and mapping of critical areas of the brain to make sure they aren't cut out. The death rate from surgery in the brain has decreased from about 30% to
just 3%. Interestingly, the brain itself has no nerves to feel pain, but it's outer
linings and the scalp do. Therefore, brain surgery may be performed with the patient
awake and conversing with the surgeon. To do the actual surgery, the scalp area is shaved,
and a hole is cut into the skull which is called a "craniotomy". For
pituitary tumors, it may be possible to insert an instrument up through the nose and
through the sphenoid bone into the brain to remove them, this is called a "trans-sphenoidal resection". It is important that the surgeon remove all of the tumor if possible, called a"total resection". This may be complicated by it being attached to critical brain structures that control
breathing or movement. Therefore, while the goal of surgery is to get a "total resection"
of the tumor,the surgeon may have to settle for a more limited removal, called a "subtotal resection", which reduces or "debulks" the tumor. Some tumors are so critically located (such as in the midbrain or brain
stem) that only a biopsy is possible. When the whole tumor can't be removed (and
in high-grade tumors even if it can) additional therapy (called"adjuvant therapy" ) such as chemotherapy and/or radiation, will be necessary for cure. Some tumors
curable with surgery alone:
1) Low grade gliomas that have been totally removed, especially in
children.
2) Meningiomas, non-malignant, when totally removed.
3) Pituitary tumors (they are usually treated with bromocriptine, a drug
which reduces their size prior to surgery).
4) Pineal tumors and schwannomas, if they can be totally removed.
It is standard to get an MRI scan after surgery to see how complete the operation
was.
Surgery is also used as part of combined treatment for high-grade (more malignant)
tumors, and may be useful palliation (symptom relief) when "debulking" a large tumor
or one that has recurred after previous treatment.
Possible side effects of surgery depend upon the extent of operation, the location
of the tumor, the condition of the patient and the skill of the neurosurgeon. These
side
effects may include motor, sensory, memory, judgment, visual, or hormonal defects.
It is critically important for the surgeon to control bleeding caused by surgery (getting
good "hemostasis" is surgical parlance), since bleeding into the brain after surgery
can dramatically worsen the patient's condition. Some potential complications of any
brain surgery include operative death (about 3%), infection (10%), seizures (10%)
and blockage of the fluid flow in the brain, or leakage of cerebral spinal fluid.
This is
particularly a problem for trans-sphenoidal resection, when the fluid can leak out
of
the nose. Patient's are typically put on dexamethasone, a steroid which helps reduce
swelling, as well as anti-seizure medications like Dilantin or phenobarbital after
brain
surgery. It is expected that the normal brain tissue damaged by surgery will heal
over
several weeks to months, so that there will be gradual improvement in the patient's
condition. However, normal cells actually destroyed at surgery in the hope of getting
a better tumor removal will never be replaced, and can cause permanent deficits.
These must be carefully discussed with the patient prior to surgery. Obviously, it
is
crucial to employ a highly experienced neurosurgeon as brain surgery is as much an
art as a science.
Radiation Treatment :
Has been used for the past 50 or so years for brain tumors, especially when they are
not totally removed surgically, when they are high grade, if they are in a location
dangerous to operate upon, or if the patient cannot tolerate surgery. Modern radiation
therapy is much safer and more effective than it was in the past. It is given by a"radiation
oncologist" and who reviews the scans, designs the treatment portal, and prescribes
the radiation. The radiation oncologist also monitors the patient during treatment
to
help treat any side-effects as they arise. After an initial consultation and the decision
to proceed with radiation, patient's first get "simulated". This means the area
to treat is marked out on a replica machine. The patient lies very still on a hard
table and is
aligned with laser lights. Special X-Rays are taken to confirm the treatment position.
Watercolor marks, and eventually small tattoos, are often placed over the area to
show the treatment field. It the patient does not wish to have marks on their forehead
and scalp, a removable plastic mark may be formed over their head, and the marks
placed upon this instead. The area marked out is checked against CAT or MRI scans
to make sure it coincides with the tumor. A "safety margin" or 2 - 3 centimeters is
added to make sure the area treated adequately covers microscopic extensions of the
tumor. The simulation takes about 1 hour, and information is then placed into a
"treatment planning computer" which generates a "plan". The patient then starts treatment,
which takes only a couple minutes per day, Monday through Friday, for 4 - 7 weeks.
The last week of the treatment is often a "boost" or "cone-down" treatment, shrinking
the field to treat only the original tumor size. The treatment is painless and the patient
does not get sick or become radioactive. Amazingly, the brain tolerates radiation
very well, and tolerates much higher doses that the lung or kidney. Usual doses are
45 - 60 Gray (units of radiation) given at about 2 Gray per day. Side effects of radiation
are divided into "acute" and "late" reactions. Acute reactions occur during the treatment period, while late reactions
may occur months to years later.
Expected acute reactions include fatigue, hair loss (which is only permanent for
doses of > 50 Gray) and scalp redness and irritation. This can progress to frank
peeling of the skin and is treated with ointments like acemannan and topical steroids.
Patients may get stuffiness or even pain in their ears from eardrum irritation from
radiation. It is also possible to have some temporary swelling of the brain when
first starting treatments, which may worsen neurological symptoms. To help prevent
this, patients are often started on oral steroids, like decadron, prior to radiation therapy.
All of the acute reactions from radiation take at least several treatments before
they
appear, and they are short-term and resolve within several weeks after completing
treatment.
Possible later side-effects are long term fatigue, memory loss, mental ability
deterioration, hormonal deficiencies, and the worst complication, radiation necrosis.
This is when part of the brain dies from radiation, and it can cause headaches, seizures,
and eventual death. It can also be confused with a recurrence of the tumor. Necrotic
(that is dead) brain is first treated with steroids, but often must be removed surgically.
The greater the amount of brain irradiated, and the higher the dose, increases the
risk
of radiation necrosis, as well as the other late effects. Therefore, radiation oncologists
try to limit the volume of brain treated, and only treat the whole brain if absolutely
necessary, and never to more than 50 Gray. Smaller areas can be treated safely to
over 70 Gray, if the treatment is given as many small doses or "fractions". A further
concern about radiation, especially in low-grade tumors, is that they may become
even more aggressive from the radiation treatment. This is called"malignant degeneration" and is why many doctors are reluctant to radiate low-grade gliomas. In general, however,
radiation is safe and effective for brain tumors, and has definitely been shown to
more than double survival for high-grade brain tumors.
Surgery and Radiation Together:
Studies from the Brain Tumor Study Group in the 1960's showed that when both
surgery and radiation are both used for aggressive brain cancers, that the survival
results were better than using either treatment alone. While patients with the highest
grade glioma, glioblastoma multiforme, only lived an average of 4 months with surgery
only, they lived to an average 9 months if radiation treatments were added after surgery. It was found that patients did better if they had a total resection of
the tumor, and if the radiation dose to the tumor area was taken up to 60 Gray. There
was
no benefit, in these early studies, to higher dose radiation- just more side-effects.
Typically, a patient diagnosed with a new brain tumor is first taken to surgery where
it's total removal is attempted, an MRI scan after surgery helps to tell how much
tumor is left. The patient heals for 2 - 3 weeks and is then simulated for radiation
treatments, based upon the volume of tumor as was seen on the scans prior to surgery.
The patient is on steroids to help prevent swelling and antiseizure medicines, and
they are told not to drive or operate dangerous machinery. They get 5 - 7 weeks of
radiation, and afterwards see the radiation oncologist 2 - 4 weeks later. Usually
an
MRI scan is gotten 2- 4 months after radiation is completed, to check the tumor's
response. The tumor should continue to shrink after radiation is completed, since cells
damaged by radiation die when they try to divide. A sooner scan might show a mass
that had no living tumor cells left in it, but this would be confusing to the doctor
and
worrisome to the patient, as nothing could be done about it anyway. Thus some time
is allowed to pass for the tumor to shrink after radiation before a scan is gotten,
unless the symptoms get dramatically worse. Later scans may show residual or growing
tumor that can get further treatment, as is discussed in "latest treatments".
Chemotherapy:
Has been used in many brain cancers, as is standard therapy in some. One of the problems
with chemotherapy in this location is that the brain has a protective barrier,
called the blood-brain barrier which effectively prevents many drugs from getting into
the brain. Trials by the Brain Tumor Study Group in the 1960's and 1970's showed
that in aggressive gliomas, a particular class of agents that does cross the bloodbrain barrier, called nitrosoureas, improved survival by about 1 month when given
with radiation treatments. Nitrosoureas like BCNU (carmustine) and CCNU (lomustine)
has lung damage as a side-effect, but are usually well tolerated.
Chemotherapy given asadjuvant (extra) treatment in high-grade gliomas seemed to only improve survival (albeit slightly)
in patients under 60 years old. In patients from 40 to 60 years old, 2 year survival
rate increased from 8% to 23% when BCNU was added.
Meningiomas are not conventionally treated with chemotherapy, it doesn't improve
survival. Also, Conventional chemotherapy was not shown to improve survival in epen dymoma but newer combinations are helpful in oligodendroglioma, as will be seen.
Likewise craniopharyngiomas, pineolomas and Schwannomas are not "chemo-sensitive".
For pituitary tumors, bromocriptine (parlodel) is commonly used to suppress the
tumor growth and get it to stop secreting excessive hormones. This is the same drug
that is used to dry up a new mothers milk if she doesn't plan to nurse. It does not
cure
the tumor, but only treats it for as long as it's given.
A brain tumor for which chemotherapy is effective and standard in advanced disease
is medulloblastoma, where methotrexate is used as well as procarbazine
and hydroxyurea. Besides the usual side effects of chemotherapy (anemia, infections,
hair loss) there is a much higher complication of brain damage, ("leukoencephalopathy"), when high-dose methotrexate (a popular chemo. drug) is given after brain
irradiation. This is thought due to radiation disturbing the blood-brain barrier,
so that
the methotrexate does more damage. This problem is worse in children and the
elderly. Therefore, all the methotrexate is given prior to starting radiation to minimize
brain damage.
Overall, conventional chemotherapy, even in combination with surgery and radiation
treatments, have been disappointing at really improving survival in the
most common types of adult brain tumors, gliomas and meningiomas.
Latest, Effective Treatments for Brain Tumors:
Surgery Advances:
For recurrent gliomas, improved survival is seen when the growing cancer is again
surgically removed. Surgery may even be performed every couple of months to "debulk"
the tumor, which improves symptoms and makes chemotherapy more effective. The downside, of course, is the danger of craniotomy and a brain operation.
Radiation Advancements:
The main problem with conventional radiation for gliomas is that the doses required to obliterate them (up to 120 Gray) exceed the normal brain's radiation tolerance.
Studies have shown poorer survival when patient's get 70 Gray than when they get
60 Gray in once-per-day treatments, owing to brain damage. In general, if lower
doses are given more than once per day, total higher doses of radiation can be given
with less normal brain damage. This is called "hyperfractionation", and although it
is inconvenient to come twice per day for treatment, 72 Gray given as 1.2 Gray twice
each day has shown the best survival results for high grade gliomas from the RTOG.
For all localized brain tumors, including astrocytoma, glioblastoma multiforme,
meningioma, pineal and pituitary tumors, the latest advancement in radiation therapy
isstereotactic radiosurgery. This procedure directly aims multiple arcs of high
dose irradiation directly on the tumor, in a single session. It is used to minimize
the
amount of normal brain irradiated, usually to boost up the dose to the tumor area
either before or after conventional "external beam" treatment. It is particularly
useful
for tumors in critical areas, such as around the optic chiasm or brain stem. The dose
given at this single treatment is usually 15 - 20 Gray, which is like 60 Gray over
time. Basically, stereotactic radiosurgery gives the benefits of opening up the skull
and doing surgery, or surgically implanting radioactive sources within the brain, without having to do any surgery at all.
The patient comes in the morning and a special "halo" is attached to their head. A
CAT or MRI scan of the brain is obtained with this halo, which keeps the patient's
head in a known position, and the area(s) to be treated are identified. Complex computer plans are then developed for the actual radiosurgery, in conjunction
with a neurosurgeon and a physicist. The patient is then called to the radiation
oncology department, a placed into a modified Linear Accelerator (Linac) or a Gamma
Knife (Cobalt-60) machine. Each tumor area is then treated, it may take several hours.
The treatment is painless and afterward the halo is removed. The patient may be discharged that very day, or stay overnight for observation. Data is accumulating showing
the effectiveness of this treatment, which is given at many University Hospitals.
Brain tumor treatment with neutron beams at the U. of Chicago have not been
shown to increase survival in malignant glioma, and high dose neutrons actually lower
survival by causing brain damage.
Another use of radiation is instilling radioactive colloids, like Phosphorus-32,
directly into craniopharyngiomas which makes them slowly shrink. This is much safer
than historic craniotomy for removing this tumor.
Chemotherapy Advances:
While past chemotherapy, except for medulloblastoma, had been disappointing,
there is now renewed interest in chemotherapy combined with surgery and radiation.
New chemotherapy has shown responses in oligodendroglioma, ependymoma,
astrocytoma, glioblastoma multiforme and germinoma. Newer combinations for
glioma include procarbazine, CCNU and vincristine. Small trials have shown even
total disappearance of oligodendrogliomas treated with these 3 drugs. For high-grade
gliomas, the best results on record come from Northern California Oncology Group
(NCOG) which studied 310 patients with malignant gliomas who got a "halogenated
pyrimidine" called BUDR weekly during radiation therapy, followed bu 1 year of che
motherapy with lomustine, procarbazine and vincristine. Median survival for patients
with anaplastic astrocytoma was 5 years, compared to 10% survival for this tumor
at 5 years with conventional treatment of surgery followed by radiation. Another
group of drugs with encouraging results in gliomas are the "polyamine inhibitors"
like Alpha-difluoromethyl-ornithine-methyl-bisguanylhydrazone (DFMO-MGBG) with about
50%
of patients responding to these drugs. Importantly, 95% of patients who failed radiation for anaplastic astrocytoma have had a stabilization of their disease from at
least
15 months! Even patients with glioblastoma multiforme were stabilized for 9.3 months
and improved survival was seen even in patients who had failed nitrosourea chemotherapy.
Chemotherapy has shown no survival benefit for low-grade glioma, meningioma,
craniopharyngioma or pinealomas.
Gene Therapy
This is an exciting area of development - if we can get a message into cancer cells
to stop them from dividing and growing, we could cure tumors without having to poison normal cells in the area with radiation and chemotherapy. Brain cancer cells tend
to make their own growth factors, and if they can be shut off then the tumor will
cease
to grow. Unfortunately, no gene therapy has yet cured brain cancers, but this research
is progressing rapidly.
Our conclusion is that the new approaches involving exacting surgery to maximally
reduce brain tumors, hyperfractionated and stereotactic radiosurgery to further shrink
the tumor, and chemotherapy in gliomas are giving better and safer survival than
ever before for every known type of brain tumor.
Brain cancer is one of the most devastating forms of cancer, so finding cancer treatment centers is of the utmost importance. Other forms of cancer, such as mesothelioma and leukemia, may be caused by environmental factors, which is why mesothelioma lawyers may be helpful to contact.
This is the full transcript, offered freely in the spirit of internet sharing, of CancerAnswers' report on Brain Cancer Treatment. Much more, including latest additional treatments for Brain Cancer can be found on our order page. Thank you for using CancerAnswers as your information resource.
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