Noninfiltrating Astrocytomas

These tumors include juvenile pilocytic astrocytomas, which most commonly occur in the cerebellum in young individuals, and the subependymal giant cell astrocytomas, which is almost always associated with tuberous sclerosis. In most cases, these astrocytomas are cured by surgery alone. Radiation therapy may be given, particularly if the tumor is not completely removed.

Low-grade Astrocytomas (Infiltrating or Diffuse Astrocytomas)

Because these tumors infiltrate normal brain tissue, they are not curable by surgery. After as much of the tumor as possible is removed surgically, radiation therapy is usually given. Radiation is not, however, as effective against low-grade astrocytomas as it is against higher grade astrocytomas. In some cases radiation therapy may not be given or may be postponed until certain symptoms develop.

High-grade Astrocytomas (Infiltrating or Diffuse Anaplastic Astrocytomas, Glioblastomas)

These infiltrating astrocytomas are not curable by surgery. After as much of the tumor as possible is removed surgically, radiation therapy is given, usually followed by chemotherapy. The most commonly given drug is called BCNU. It is given intravenously. Many other drugs and combinations of drugs have been studied but none have been shown to produce better results. Various clinical trials offer promising but unproven new treatments.

Lymphomas

These tumors are not curable with surgery because they tend to be spread widely through the brain and may be found in many places within it. The role of surgery is for biopsy and diagnosis only. Standard treatment is radiation therapy to the whole brain. Chemotherapy may also help, particularly in people without AIDS. Brain lymphomas respond better to chemotherapy than do other brain tumors and many different combinations of drugs appear to be effective. Corticosteroids (cortisone-like drugs) are also beneficial and may help shrink the tumor. In people without AIDS, treatment with radiation and chemotherapy can produce long lasting remissions.

The success rate is lower in people with this disease who also have an immune deficiency disease like AIDS. Brain lymphomas occur in two to six percent of people with far-advanced AIDS. Although people with AIDS may respond to the treatment, particularly radiation, their disease may be so advanced that their survival is short. Chemotherapy is less useful in people with brain lymphomas and AIDS because they are unable to tolerate its side effects.

Because brain lymphomas can also involve the spinal fluid, a lumbar puncture is usually done. If the spinal fluid has lymphoma cells, then chemotherapy must be injected into the spinal canal several times. Although this can be done with many lumbar punctures, most doctors prefer to place a device called an Ommaya reservoir into the spinal fluid. This device is actually placed under the scalp. A very thin tube leads from this into the spinal fluid. Chemotherapy can be injected through the rubber cap that seals the top of this device. This lies just under the skin of the skull and repeated injections here are much more comfortable than repeated lumbar punctures.

Oligodendrogliomas

These infiltrating tumors are usually not curable by surgery, although surgical treatment can relieve symptoms and prolong survival. If the tumor is causing disability, oligodendrogliomas are treated after surgery by chemotherapy, sometimes followed by radiation therapy.

Ependymomas

These tumors do not infiltrate normal brain tissue and may be cured by surgery alone. If not completely removed by surgery, radiation therapy is given.

Meningiomas

These tumors can usually be cured if completely removed surgically. Some, particularly those at the base of the brain, cannot be completely removed and a few are malignant and recur despite apparently complete removal. Radiation therapy may control regrowth of meningiomas that cannot be completely removed or those that recur after surgery. Chemotherapeutic or hormonal agents are experimental and have no proven benefit. Because of their slow growth, small or asymptomatic meningiomas, particularly in the elderly, can usually be watched rather than treated.

Schwannomas

These tumors are usually benign and are effectively cured by surgical removal. In some centers small acoustic schwannomas are treated by stereotactic radiosurgery. For malignant schwannomas, radiation therapy is often given after surgery.

Spinal Cord Tumors

These tumors are treated in a manner similar to those in the brain. Meningiomas are cured by surgical removal, as are some ependymomas of the spinal cord. If surgical removal of an ependymoma is incomplete, it is followed by radiation therapy. Astrocytomas of the spinal cord cannot be totally resected and are treated, after biopsy, by radiation therapy.

Some brain tumors occur more commonly in children but do occur occasionally in adults. These tumors include brain stem astrocytomas, germ cell tumors, pineal region tumors, craniopharyngiomas, choroid plexus tumors, medulloblastomas, and primitive neuroectodermal tumors. Treatment of these cancers is described in a separate document "Brain and Spinal Cord Cancers of Children."