ON THIS PAGE: You will learn about the different types of treatments doctors use for people with a brain tumor. Use the menu to see other pages.
This section explains the types of treatments, also known as therapies, that are the standard of care for a brain tumor. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for a brain tumor in the United States. Treatment options can vary from one place to another.
When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all types of brain tumors. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
How a brain tumor is treated
In brain tumor care, different types of doctors who specialize in cancer, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatment. This is called a multidisciplinary team. Your care team may include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, rehabilitation specialists, and others. It is important to have a care team that specializes in caring for people with a brain tumor, which may mean talking with medical professionals beyond your local area to help with diagnosis and treatment planning. Learn more about the clinicians who provide cancer care.
Treatment options and recommendations depend on several factors:
The size, type, and grade of the tumor
Whether the tumor is putting pressure on vital parts of the brain
If the tumor has spread to other parts of the central nervous system (CNS) or body
Possible side effects
The patient’s preferences and overall health
Some types of brain tumors grow rapidly; other tumors grow slowly. Considering all these factors, your doctor will talk with you about how soon treatment should start after diagnosis.
For a low-grade brain tumor, surgery may be the only treatment needed, especially if all of the tumor can be removed in younger patients. If there is visible tumor remaining after surgery, radiation therapy and chemotherapy may be used. For higher-grade tumors, treatment usually begins with surgery, followed by radiation therapy and chemotherapy, often after a period of recovery. Your exact treatment plan will be developed with your health care team.
Successfully treating brain tumors can be challenging. The body’s blood-brain barrier normally protects the brain and spinal cord from harmful chemicals. This barrier also keeps out many types of chemotherapy. Surgery can be difficult if the tumor is near a delicate part of the brain or spinal cord. Even when the surgeon can completely remove the original tumor, parts of the tumor may remain that are too small to be seen or removed during surgery. Radiation therapy can also damage healthy tissue.
However, research in the past 20 years has helped to significantly lengthen the lives and improved the quality of life for many people with a brain tumor. These advancements include more refined surgeries, a better understanding of which types of tumors respond to chemotherapy and other drugs, and more targeted delivery of radiation therapy.
Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for a brain tumor because there are different treatment options. Learn more about making treatment decisions.
Treatment options include those described below, such as surgery, radiation therapy, chemotherapy, and targeted therapy. Your care plan may also include treatment for symptoms and side effects, an important part of your medical care.
A brain tumor and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the tumor.
Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of tumor, may receive this type of care. And it often works best when it is started right after a brain tumor diagnosis. People who receive palliative and supportive care along with treatment for the tumor often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as chemotherapy, surgery, or radiation therapy, to improve symptoms.
Some of the symptoms of a brain tumor can be severe and have an enormous impact on the daily lives of patients and their family caregivers. However, many symptoms can often be managed with the use of certain medications. Supportive care for people with a brain tumor includes:
Corticosteroids. These drugs are used to lower swelling in the brain, which can lessen headache pain from the swelling without the need for prescription pain medications. These drugs may also help improve neurological symptoms by decreasing the pressure from the tumor and swelling in the healthy brain tissue.
Anti-seizure medicines. These help control seizures, and there are several types of drugs available. These medications are prescribed by your neurologist.
Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.
Treatment for a brain tumor is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.
During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is usually the first treatment used for a brain tumor. It is often the only treatment needed for a low-grade brain tumor. Removing the tumor can improve neurological symptoms, provide tissue for diagnosis and genetic analysis, help make other brain tumor treatments more effective, and, in many instances, improve the prognosis of a person with a brain tumor.
A neurosurgeon is a doctor who specializes in surgery on the brain and spinal column. Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient's own bone will be used to cover the opening in the skull.
There have been rapid advances in surgery for brain tumors, including the use of cortical mapping, enhanced imaging, and fluorescent dyes.
Cortical mapping allows doctors to identify areas of the brain that control the senses, language, and motor skills.
Enhanced imaging devices give surgeons more tools to plan and perform surgery. For example, computer-based techniques, such as image guided surgery (IGS), help surgeons map out the location of the tumor very accurately. However, this is a very specialized technique that may not be widely available.
A fluorescent dye, called 5-aminolevulinic acid, can be given by mouth the morning before surgery. This dye is taken up by tumor cells. Doctors can use a special microscope and light to see the cells that have taken up the dye during the surgery. This helps doctors safely remove as much of the tumor as possible.
For a tumor that is near the brain’s speech center, it is increasingly common to perform the operation when the patient is awake for part of the surgery. Typically, the patient is awakened once the surface of the brain is exposed. Then, special electrical stimulation techniques are used to locate the specific part of the brain that controls speech. This approach can help avoid causing damage while removing the tumor.
In addition to removing or reducing the size of the brain tumor, surgery can provide a tissue sample for an analysis using a biopsy (see Diagnosis). For some tumor types, the results of the biopsy can help determine if cancer medications or radiation therapy will be useful. For a cancerous tumor, even if it cannot be cured, removing it can relieve symptoms from the tumor pressing on the brain.
Sometimes, surgery cannot be performed because the tumor is located in a place the surgeon cannot reach or it is near a vital structure. These tumors are called inoperable or unresectable. If the tumor is inoperable, the doctor will recommend other treatment options that may also include a biopsy or removal of a portion of the tumor.
Laser interstitial thermal therapy (LITT) is a newer technique that can sometimes be used to treat malignant brain tumors that are unresectable. Following a biopsy to confirm the presence of the tumor, the neurosurgeon inserts a catheter containing a rotating laser, which can be used to heat up and eliminate the zone of tumor surrounding the catheter tip. This procedure is performed with the help of an intraoperative magnetic resonance imaging (MRI) scan that produces real-time images of the volume of tissue that is being heated. This is done to allow the neurosurgeon to carefully control and limit the effects of the LITT to the surrounding tumor and avoid damaging healthy brain tissue.
Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of surgery.
Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. Doctors may use radiation therapy to slow or stop the growth of a brain tumor. It is typically given after surgery and possibly along with chemotherapy. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist.
The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
External-beam radiation therapy can be directed at a brain tumor in the following ways:
Conventional radiation therapy. The treatment location is determined based on anatomic landmarks and x-rays. In certain situations, such as whole-brain radiation therapy for brain metastases, this technique is appropriate. For more precise targeting, different techniques are needed. The amount of radiation given depends on the tumor’s grade.
3-dimensional conformal radiation therapy (3D-CRT). Using images from computed tomography (CT) and magnetic resonance imaging (MRI) scans (see Diagnosis), a 3-dimensional model of the tumor and healthy tissue surrounding the tumor is created on a computer. This model can be used to aim the radiation beams directly at the tumor, sparing the healthy tissue from high doses of radiation therapy.
Intensity modulated radiation therapy (IMRT). IMRT is a type of 3D-CRT (see above) that can more directly target a tumor. It can deliver higher doses of radiation to the tumor while giving less to the surrounding healthy tissue. In IMRT, the radiation beams are broken up into smaller beams and the intensity of each of these smaller beams can be changed. This means that the more intense beams, or the beams giving more radiation, can be directed only at the tumor.
Proton therapy. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy tumor cells. Proton beam therapy is typically used for tumors when less radiation is needed because of the location. This includes tumors that have grown into nearby bone, such as the base of skull, and those near the optic nerve.
Stereotactic radiosurgery.Stereotactic radiosurgery is the use of a single, high dose of radiation given directly to the tumor and not healthy tissue. It works best for a tumor that is only in 1 area of the brain and certain noncancerous tumors. It can also be used when a person has more than 1 metastatic brain tumor. There are many different types of stereotactic radiosurgery equipment, including:
A modified linear accelerator is a machine that creates high-energy radiation by using electricity to form a stream of fast-moving subatomic particles.
A Gamma Knife is another form of radiation therapy that concentrates highly focused beams of gamma radiation on the tumor.
A Cyber Knife is a robotic device used in radiation therapy to guide radiation to the tumor, particularly in the brain, head, and neck regions.
Fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision but divided into small daily doses called fractions and given over several days or weeks, in contrast to the 1-day radiosurgery. This technique is used for tumors located close to sensitive structures, such as the optic nerves or brain stem.
With these different techniques, doctors are trying to be more precise and reduce radiation exposure to the surrounding healthy brain tissue. Depending on the size and location of the tumor, the radiation oncologist may choose any of the above radiation techniques. In certain situations, a combination of multiple techniques may work best.
Short-term side effects from radiation therapy may include fatigue, mild skin reactions, hair loss, upset stomach, and neurologic symptoms, such as memory problems. Most side effects go away soon after treatment is finished. Also, radiation therapy is usually not recommended for children younger than 5 because of the high risk of damage to their developing brains. Longer term side effects of radiation therapy depend on how much healthy tissue received radiation and include memory and hormonal problems and cognitive (thought process) changes, such as difficulty understanding and performing complex tasks.
Learn more about the basics of radiation therapy.
Therapies using medication
The treatment plan may include medications to destroy tumor cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.
This treatment is generally prescribed by a neuro-oncologist, who is either a medical oncologist or neurologist physician who specializes in treating brain cancer with medication.
Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). It may also be given through a catheter or port, which are used to make IV injections easier. If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.
The types of medications used for a brain tumor include:
Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.
The medications used to treat a brain tumor are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with the medications used for a brain tumor, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.
Chemotherapy is the use of drugs to destroy tumor cells, usually by keeping the tumor cells from growing, dividing, and making more cells.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. The goal of chemotherapy can be to destroy tumor cells remaining after surgery, slow a tumor’s growth, or reduce symptoms.
As explained above, chemotherapy to treat a brain tumor is typically given after surgery and possibly with or after radiation therapy, particularly if the tumor has come back after initial treatment.
Some drugs are better at going through the blood-brain barrier. These are the drugs often used for a brain tumor, such as temozolomide (Temodar), lomustine (CCNU), or others.
For people with glioblastoma and high-grade glioma, the latest standard of care is radiation therapy with daily low-dose temozolomide. This is followed by monthly doses of temozolomide after radiation therapy for 6 months to 1 year.
For people with anaplastic astrocytoma that is newly diagnosed or has not responded to treatment, temozolomide may be part of the recommended treatment plan.
A combination of 3 drugs, lomustine, procarbazine (Matulane), and vincristine (Vincasar), has been used along with radiation therapy. This combination is sometimes called PCV. This approach has helped lengthen the lives of patients with grade 2 or 3 oligodendroglioma with a 1p/19q codeletion (see also, "Molecular features" in the Grades and Prognostic Factors section) when given either before or, more commonly, right after radiation therapy. It has also been shown to lengthen lives of patients after radiation therapy for a low-grade glioma that could not be completely removed with surgery, particularly those low-grade tumors which have mutations of the IDH gene. Clinical trials on the use of chemotherapy to delay radiation therapy for patients with low-grade glioma are ongoing, as are clinical trials to determine if temozolomide can be substituted for PCV in the patients described above.
Gliadel wafers are a way to give the drug carmustine (BiCNU). These wafers are placed in the area where the tumor was removed during surgery.
Patients are monitored with brain magnetic resonance imaging (MRI) every 2 to 3 months while receiving active treatment. Then, the length of time between MRI scans increases depending on the tumor’s grade. Patients often have regular MRIs to monitor their health after treatment is finished and the tumor has not grown. If the tumor grows during treatment, other treatment options will be considered.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished. Rarely, certain drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid by IV to protect their kidneys.
Learn more about the basics of chemotherapy.
In addition to standard chemotherapy, targeted therapy is another way doctors use medication to treat cancer. Targeted therapy is a treatment that targets the tumor’s specific genes, proteins, or the tissue environment that contributes to a tumor’s growth and survival. This type of treatment blocks the growth and spread of tumor cells and limits the damage to healthy cells.
Not all tumors have the same targets, and some tumors may have more than 1 target. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This is called biomarker or molecular testing. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.
For a brain tumor, there are several types of targeted therapy that may be used:
Bevacizumab (Avastin, Mvasi) is an anti-angiogenesis therapy used to treat glioblastoma multiforme when previous treatment has not worked. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapy is to “starve” the tumor. ASCO does not recommend bevacizumab for people with newly diagnosed grade 4 glioblastoma that does not have an IDH mutation.
Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are a type of targeted therapy that is not specific to a certain type of tumor but focuses on a specific genetic change called an NTRK fusion. This type of genetic change is found in a range of tumors, including some brain tumors. These drugs are approved to treat some brain tumors that are metastatic or cannot be removed with surgery and have worsened with other treatments.
Dabrafenib (Tafinlar) with trametinib (Mekinist) are approved for use in combination in tumors that contain BRAF mutations. These drugs can be effective in adult and pediatric malignant brain tumors, including gliomas, that contain BRAF mutations, particularly the V600E BRAF mutation.
A variety of other targeted therapies are being studied in brain tumors that contain other specific molecular changes, such as IDH and FGFR fusions. Talk with your doctor about the possible side effects for a specific medication and how they can be managed.
This type of treatment uses a noninvasive portable device that interferes with the parts of a cell that are needed for tumor cells to grow and spread. It is given by placing electrodes that produce an electric field on the outside of a person’s head. The available device is called Optune.
Alternating electrical field therapy may be an option for people newly diagnosed with glioblastoma or for those with recurrent glioblastoma. Researchers have found that people with recurrent glioblastoma who used the device lived as long as those who received chemotherapy. In addition, they had fewer side effects. Other research shows that people newly diagnosed with glioblastoma lived longer and were less likely to have the disease worsen when this treatment was used along with temozolomide after radiation therapy. This treatment approach is now considered a recommended option for people with glioblastoma.
Oligodendroglioma. For people with grade 2 or grade 3 oligodendroglioma with a 1p/19q codeletion and an IDH genetic mutation (see Diagnosis), ASCO recommends radiation therapy in combination with the chemotherapy drugs lomustine, procarbazine, and vincristine, which together are called PCV (see “Chemotherapy,” above). When radiation therapy and chemotherapy are given at the same time, it is called chemoradiation. For certain people with this type of grade 2 tumor, treatment may not begin until the tumor causes symptoms or imaging scans show that the tumor is growing.
Astrocytoma. ASCO recommends that people with grade 2 astrocytoma with an IDH genetic mutation and no 1p/19q codeletion be offered radiation therapy followed by chemotherapy with either the single drug temozolomide (Temodar) or with the PCV combination. Some people with this type of grade 2 tumor may be able to delay treatment until the tumor causes symptoms or imaging scans show that the tumor is growing. People with grade 3 astrocytoma with an IDH genetic mutation and no 1p/19q codeletion should be offered radiation therapy followed by temozolomide or both of these treatments given at the same time. Likewise, people with grade 4 astrocytoma with an IDH genetic mutation may be offered radiation therapy followed by temozolomide or both of these treatments given at the same time. Some astrocytomas without an IDH mutation may be treated the same way as glioblastoma that also does not have an IDH mutation (see below).
Glioblastoma. For most people with newly diagnosed grade 4 glioblastoma or a grade 2 or 3 astrocytoma and no IDH genetic mutation, ASCO recommends treatment with radiation therapy and temozolomide chemotherapy given at the same time. After this treatment, 6 months of temozolomide is recommended. Alternating electric field therapy (see above) may also be recommended for grade 4 glioblastoma located in the upper part of the brain. If the recommended treatment regimen becomes too difficult to complete, the doctor will recommend treatment with supportive care, hypofractionated radiation therapy, and/or temozolomide.
This information is based on the ASCO and Society for Neuro-Oncology (SNO) guideline, “Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults.” Please note that this link takes you to another ASCO website.
A remission is when the tumor cannot be detected in the body. A remission can be temporary or permanent.
For most primary brain tumors, despite imaging tests showing that the tumor growth is controlled or there are no visible signs of a tumor, it is common for a brain tumor to recur.
Patients will often continue to receive regular MRI scans to watch for a recurrence. This uncertainty causes many people to worry that the tumor will come back. It is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.
If the tumor returns after the original treatment, it is called a recurrent tumor. A recurrent brain tumor generally comes back near where it originally started. Rarely, it may come back in another place or in several areas, which is called a multifocal recurrence.
If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, radiation therapy, chemotherapy, and targeted therapy, but they may be used in a different combination or given at a different pace. Options may include:
Alternating electric field therapy for people with recurrent high-grade glioma
Clinical trials studying new treatments
There is no single approach to treating a recurrent brain tumor, and your treatment plan will be based on many factors. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects. Your doctor may suggest clinical trials of new drugs that are being created and tested to treat brain tumors that may help with recurrent tumors. Many of these new drugs are called "molecular targeted therapies" because they are small in size, which means they can be taken by mouth and/or can target specific parts of the brain tumor cells (see "Targeted therapy," above). These new drugs are being tested either alone or in combination with standard chemotherapy. Learn more about clinical trials on brain tumor treatment in the Latest Research section.
People with a recurrent brain tumor sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. It may also be helpful to talk with other patients, including through a support group. Learn more about dealing with a recurrence.
If cancer spreads from where it started to another part of the body, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.
For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.
Your treatment plan may include a combination of surgery, radiation therapy, targeted therapy, and immunotherapy, which is a type of treatment designed to boost the body's natural defenses to fight the tumor. Learn more about immunotherapy below and in the Latest Research section of this guide.
Treatment of brain metastases
If cancer spreads to the brain from another part of the body, it is called a brain metastasis, metastatic cancer, or a secondary brain tumor. Brain metastases have traditionally been treated with surgery or radiation therapy. Chemotherapy is not often used because the blood-brain barrier keeps many drugs from reaching the brain. In the past, chemotherapy was mostly used only if radiation therapy did not work. However, other medications like targeted therapy and another type of medication approach called immunotherapy are options for certain people. Current options for treating brain metastases include:
Surgery. Surgery is generally only an option for patients who have 1 or 2 areas of metastatic cancer in the brain, especially when the tumors are large and causing symptoms. On occasion, patients with multiple areas of cancer in the brain who have a single large lesion causing symptoms will also be considered for surgery. Some patients with more than 2 lesions that are located close to each other may also be able to have multiple lesions removed with surgery. Radiation therapy is most often given afterward and sometimes before.
Radiation therapy. For most people with 1 to 4 tumors, high-dose radiation therapy given using stereotactic techniques (see "Radiation therapy," above) is preferred. Some people with 5 to 10 tumors may also be offered stereotactic radiosurgery. Stereotactic radiosurgery focuses the radiation only on the tumor in the brain, and this can also help lessen the side effects. The dose of radiation may be given in 1 treatment, called a single fraction, or across multiple treatments, called multifraction. Whole-brain radiation therapy is radiation therapy given to the entire brain, and it may be an option for some people. If whole-brain radiation therapy is given, your doctor may recommend techniques to avoid exposing the hippocampus to radiation, if possible, and giving a medication called memantine (Namenda), which can help with thinking problems.
Targeted therapy.Some types of targeted therapy can enter brain tumors and are able to target specific genetic changes in cancer that reaches the brain from metastatic disease that began elsewhere. These include:
Osimertinib (Tagrisso) or icotinib (Conmana) for metastatic non-small cell lung cancer (NSCLC) that has a genetic change on the EGFR gene (icotinib is being tested in clinical trials and has not been approved by the U.S. Food and Drug Administration for this purpose.)
Alectinib (Alecensa), brigatinib (Alunbrig), or ceritinib (Zykadia) for metastatic NSCLC with a genetic change on the ALK gene
Tucatinib (Tukysa), trastuzumab (Herceptin), and capecitabine (Xeloda) may be used for HER2-positive metastatic breast cancer
Dabrafenib (Tafinlar) with trametinib (Mekinist) may be used for metastatic melanoma
Immunotherapy. Some types of immunotherapy have shown promise in treating brain metastases from lung cancer and melanoma. These include ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda). Immunotherapy is another type of cancer therapy using medication. Learn more about immunotherapy in the Latest Research section of this guide.
Below is a general summary of when and how surgery and radiation therapy are used to treat brain metastases:
People with up to 4 brain metastases generally receive stereotactic radiosurgery. If the brain metastases are large or causing symptoms due to pressure on the brain and the person is in general good health, they often receive surgery followed by stereotactic radiosurgery.
Treatment for people in relatively good health and with more than 4 tumors that cannot be removed with surgery or more than 2 tumors that were removed surgically may include stereotactic radiosurgery or whole brain radiation therapy.
People who also have metastatic cancer in parts of the body other than the brain usually continue their treatment regimen if the disease outside the brain is not worsening. If the disease is worsening, the treatment plan may be changed based on the recommendations for that type of metastatic cancer.
The information in this section is based on a joint guideline from ASCO, the Society for Neuro-Oncology (SNO), and the American Society for Radiation Oncology (ASTRO), “Treatment for Brain Metastases,” and ASCO’s endorsement of the ASTRO guideline, “Radiation Therapy for Brain Metastases.” Please note that these links take you to a different ASCO website.
Treatment of leptomeningeal metastases
If cancer spreads to the meninges or the cerebrospinal fluid (CSF), it is called leptomeningeal metastases. People with leptomeningeal metastases may receive chemotherapy given directly into the CSF of the brain. This may be done with a lumbar puncture and is called intrathecal chemotherapy. Or it may be given using a catheter with a reservoir, called an Ommaya reservoir. Radiation therapy may also be an option.
Managing the symptoms and side effects of brain metastases
The symptoms of brain metastases depend on where in the brain the cancer has spread, how much cancer is in the brain, and how quickly it spreads.
Relieving a person's symptoms and side effects is an important part of cancer care. Treatment for symptoms can continue even when active treatment to cure or slow down the cancer stops. Be sure to talk with the health care team about new symptoms or changes to existing symptoms.
ASCO recommends the following options to help relieve symptoms of brain metastases:
Dexamethasone (available as a generic drug), a type of drug called a corticosteroid, to lower swelling in the brain and help improve neurological symptoms caused by the tumor and swelling in the healthy brain tissue.
Anti-seizure medications are only recommended for people who are having seizures.
Learn about other options to help manage the symptoms of brain metastases.
Recovery from a brain tumor is not always possible. If the tumor cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, an advanced brain tumor is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.
People who have an advanced brain tumor and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with a brain tumor. Use the menu to choose a different section to read in this guide.