The primary goal of managing brain tumours is to remove as much cancerous tissue while maintaining the surrounding brain structures.
Treatment involves a multidisciplinary team of specialists, including neurosurgeons, neurologists, neuroradiologist, neuropathologists, oncologists, nurse clinicians and allied health professionals (therapists, social workers, psychologists, dieticians) who work together to develop a management plan personalised to the patient's needs and tumour profile.
Treatment depends on the tumour's size, location, grade, sub-type, how much was removed for testing and the patient's general health. For gliomas graded 2 to 4, treatment often aims to control the tumour's growth or relieve symptoms, but it is unable to cure the tumour.
Treatment approaches include:
Patients are regularly monitored to track the progression of the tumour. This approach is suitable for patients with slow-growing tumours that do not present symptoms, where the potential risks of any procedure may outweigh the benefits.
Surgical removal of the tumour is often the initial treatment for glioma. The amount of cancerous tissue to be removed depends on the tumour's grade and location. Complete removal may not always be possible, especially if the tumour is near critical brain regions responsible for functions such as breathing. In these cases, the goal is to remove as much of the tumour as possible while keeping brain function intact. Other surgical techniques, such as imaging and brain mapping, help surgeons during the tumour removal process.
Some may undergo an awake craniotomy, a surgery that is performed while the patient is conscious and able to respond to simple instructions, but unable to feel any pain. An awake craniotomy reduces the risk of damage to critical brain regions close to the tumour.
The risk of surgery depends on multiple factors including the patient's age, medical history and location of the tumour. These risks may include infection, bleeding, seizures, paralysis and coma.
Radiation therapy is commonly used either as a treatment on its own or together with surgery and chemotherapy. External Beam Radiation Therapy (EBRT) directs high-energy particles such as x-rays, photons, or protons to target and destroy glioma cells. Radiation therapy aims to shrink tumours, prevent them from growing, and reduce the likelihood of recurrence.
Depending on the size and spread of the tumour, and the patient's overall health condition, radiation therapy may be given five days a week for three to six weeks. The first session will usually start within six weeks of the surgery, depending on how well the surgical wound has healed. Prior to radiation therapy, the patient would need to go for a simulation CT scan. During the session, a plastic shell will also be custom made for each patient. This shell will help to hold the head and neck in position during therapy.
Your doctor will discuss potential side-effects and how to cope with them before radiation therapy is started. Short-term side effects of radiation therapy can include fatigue, headaches, hair loss and scalp irritation. Longer term side effects may vary depending on your treatment.
Chemotherapy involves the use of drugs to stop cancer cells from multiplying. Drugs are delivered throughout the body via the bloodstream (systemic chemotherapy), targeting the primary tumour and potential tumours that have spread to other parts of the body.
Alternatively, a dissolvable wafer may be placed at the tumour site after surgery, allowing the chemotherapy to target the remaining cancer cells. This targeted approach minimises side effects while improving treatment results.
The most common form of chemotherapy for high-grade glioma is Temozolomide, however this medication is only effective in certain sub-types of glioma. Temozolomide is a capsule to be taken orally. The standard treatment is to start Temozolomide at the same time as radiation therapy followed by another six cycles of chemotherapy given over six months.
Side effects of Temozolomide include fatigue, nausea, liver injury, constipation, decreased white blood cell count or platelet count.
