Brain Tumors
	Tumors of the brain include both tumors which grow from brain tissues (called “primary brain tumors”) and those which begin elsewhere in the body and spread to the brain (called “metastases”) Both types of tumors cause similar types of symptoms such as headache, vomiting, visual and gait problems. However, they require very different treatments. For most primary brain tumors, some type of surgery is usually necessary to determine just what type of tumor the patient has. This might mean having a small biopsy taken of the tumor, or a larger operation to remove as much of the
tumor as possible. Once the type of tumor is known, post-operative treatment can be tailored to the patient’s needs. Generally, however, this involves a combination of chemotherapy and radiation.

Radiation is a very important part of the treatment of adult brain tumors. It is not usually possible for surgeons to completely eradicate brain tumors due to the importance of the surrounding normal brain. Radiation treatments use a powerful beam of x-rays to kill any cancer cells which may be left in the brain. In adults, this is generally a very safe treatment as the brain tolerates radiation quite well. It does cause patchy hair loss which is usually temporary, and some patients experience a bit of excessive sleepiness for a few weeks following treatment.

New chemotherapy drugs which penetrate into the brain have been shown to make radiation treatments more effective and some of them can be given in pill form.

Treatment of metastases is quite different because multiple sites in the brain are usually involved, radiation is given to the entire brain—causing total hair loss. Also, because this usually occurs in the setting of advanced cancer, patients often have other medical problems to deal with.

For both types of a tumors, a novel technique exists to put a “booster dose” of radiation exactly where it is most needed. This is called “Stereotactic Radiosurgery” and can be used for any tumor equal to or smaller than 3 centimeters in size (a little more than an inch). Recent scientific studies seem to indicate that this booster dose does improve outcomes. Stereotactic Radiosurgery uses a radiation beam to create a pinpoint hole deep in the brain without having to do an operation. It can be used to treat tumors which are too deep to operate on easily. The patient wears a head frame pinned into the skull bone which has special metal markers on it. A scan of the head is done to locate the position of the tumor in relation to the head frame. The patient’s head is attached to the end of the treatment couch so that the linear accelerator can move around the head in all directions. By angling the table relative to the machine, we can draw large arcs of radiation through the brain. This spreads out the dose over the normal brain so no part receives too much. However, where all the arcs intersect, the dose is tremendous—enough to create a very precise burn.

Notice the graphic. This is from our Stereotactic Radiation Therapy treatment planning computer at the St. Joseph's Cancer Care Center, Tampa, Florida. You can see the outline of the skull, the eyes, the nerves from the eyes to the brain, the brainstem, and the tumor.

This is from our Stereotactic Radiosurgery treatment
planning computer. You can see the outline of the skull,
the eyes, the nerves from the eyes to the brain, the brainstem, and the tumor.