Brain tumor medical therapy: Difference between revisions

Jump to navigation Jump to search
m (Bot: Removing from Primary care)
 
(12 intermediate revisions by 2 users not shown)
Line 4: Line 4:


==Overview==
==Overview==
Although there is no generally accepted therapeutic management for primary brain tumors, a surgical attempt at tumor removal or at least cytoreduction (that is,  removal of as much tumor as possible, in order to reduce the number of tumor cells available for proliferation) is considered in most cases<ref>Nakamura M, Konishi N, Tsunoda S, Nakase H, Tsuzuki T, Aoki H, Sakitani H, Inui T, Sakaki T. ''Analysis of prognostic and survival factors related to treatment of low-grade astrocytomas in adults.'' Oncology 2000;58:108-16. PMID 10705237.</ref>. However, due to the infiltrative nature of these lesions, tumor recurrence, even following an apparently complete surgical removal, is not uncommon. Postoperative radiotherapy and chemotherapy are integral parts of the therapeutic standard for malignant tumors. Radiotherapy may also be administered in cases of "low-grade" gliomas, when a significant tumor burden reduction could not be achieved surgically.
The predominant therapy for brain tumor is surgical resection. Adjunctive chemotherapy and radiation may be required.


Chemotherapy may be used with surgery or radiation treatment.
==Medical Therapy==
==Medical Therapy==
Some drugs that are used t treat Brain Cancer are:
Some drugs that are used to treat brain cancer are:


*'''Everolimus'''- FDA approved - approved to treat [[Subependymal giant cell astrocytoma]] in patients who have [[Tuberous Sclerosis]] and are not able to have surgery.
*'''Everolimus'''- FDA approved - approved to treat [[Subependymal giant cell astrocytoma]] in patients who have [[Tuberous Sclerosis]] and are not able to have surgery.
Line 19: Line 18:
Other medications used to treat primary brain tumors in children may include:
Other medications used to treat primary brain tumors in children may include:


* Corticosteroids, such as dexamethasone, to reduce brain swelling
* Corticosteroids, such as [[dexamethasone]], to reduce brain swelling
* Medicines such as urea or mannitol to reduce brain swelling and pressure
* Medicines such as urea or [[mannitol]] to reduce brain swelling and pressure
* Anticonvulsants, such as evetiracetam (Keppra), to reduce seizures
* Anticonvulsants, such as [[evetiracetam]] (Keppra), to reduce seizures
* Pain medications
* Pain medications
* Antacids or histamine blockers to control
* Antacids or histamine blockers to control
Comfort measures, safety measures, physical therapy, and occupational therapy may be needed to improve quality of life. Counseling, support groups, and similar measures can help people cope with the disorder.
===Radiation Therapy===
In case of a malignant brain tumor, radiation therapy is needed to control the tumor and possibly acheive long-term remission.
There are some possible side effects of radiation therapy; these include the possibility of strokes and [[Dementia]]. The severity as well as the chance that they happen, worsen with higher doses of therapy. The radiation therapy is usually very well tolerated.
'''Stereotactic Radiosurgery:'''
Stereotactic radiosurgery is a special form of
radiation therapy - it is not surgery. Stereotactic
radiosurgery allows precisely focused, high dose
X-ray beams to be delivered to a small, localized
area of the brain. It is used to treat small brain and
spinal cord tumors (both benign and malignant);
blood vessel abnormalities in the brain; defined
areas of cancer; certain small tumors in the lungs
and liver; and neurologic problems such as
movement disorders.Stereotactic radiosurgery is given in
a single session. If given in multiple sessions, the
treatment may be called stereotactic radiotherapy
or fractionated stereotactic radiotherapy.
“Frameless radiosurgery” refers to radiosurgery
that does not use a metal frame to immobilize the
head during treatment. Rather, markers able to be
viewed on a scan are placed on the scalp, or a face
mask is used to help hold the head steady. The
treatment equipment is then aligned with the
markers or with the face mask.
Radiosurgery is different from Conventional Radiation therapy.
Conventional external beam radiation therapy –
the most common form of radiation therapy –
delivers full dose radiation to the tumor and some
of the surrounding brain tissue. For several
reasons, the target area for conventional radiation
deliberately includes a border (called a “margin”)
of normal brain around the tumor. These reasons
include uneven tumor borders, the risk of invisible
spread of the tumor into the surrounding tissue, a
larger tumor size, or the presence of multiple
tumors. This larger zone of full-dose radiation
includes the borders of the tumor where
microscopic tumor cells may be located.
Since normal brain tissue is included in the
full-dose region, conventional radiation is broken
down into small daily doses so the normal brain
tissue can tolerate it. As a result, reaching the
desired dose of radiation takes several weeks of
daily treatment.
Radiosurgery focuses radiation beams more
closely to the tumor than conventional external
beam radiation. This is possible through the use
of highly sophisticated computer-assisted
equipment. A head frame or facemask used for
this treatment allows very precise set up,
localization and treatment of the tumor. Using
advanced computer planning, radiosurgery
minimizes the amount of radiation received by
normal brain tissue and focuses radiation in the
area to be treated.
Since conventional radiation therapy covers more
normal tissue, it can often be given only once.
Radiosurgery, however, may be considered for
re-irradiation due to its precision and the
possibility of avoiding previously treated areas
'''Gamma knife, Linear Accelerators, Proton Beam radiosurgery units''' are the types of equipment used in Radiosurgery.  Radiosurgery requires a
team of specialists. That team may include a
neurosurgeon, radiation oncologist, radiologist,
radiation physicist, neurologist, anesthesiologist,
specially trained nurses, technologists and the unit
support staff.The actual treatment time for any of these
techniques generally ranges from 15 minutes to
about two hours.
Some people have few or no side
effects from this type of radiation therapy. Once
they have rested following the treatment and have
resumed their regular activities, tenderness at the
pin sites may be the only side effect
Early symptoms are often due to brain edema
(swelling) caused by the radiation. These
symptoms can include nausea, vomiting, dizziness,
or headaches which are usually temporary. Once the
swelling resolves, these symptoms usually resolve.
Two to three weeks after treatment, some may
experience hair loss in the area radiated, but this
does not occur in everyone. Hair loss depends on
the dose of radiation received by portions of the
scalp and the ability of the radiated hair follicles to
heal. Regrowth usually begins in 3-4 months, and
may be a slightly different color or texture than
before. The scalp may also become temporarily
irritated.
Some patients may experience delayed reactions
weeks or months after treatment. These reactions
can include necrosis or cell death in the high
radiation dose region due to swelling in reaction
to the radiation effect on the target region. These
symptoms are mainly due to swelling or death of
brain tissue in the treated area. They may mimic
the symptoms of tumor regrowth or stroke.
Treatment will be based on the type of side effect
that occurred. Other effects depend on the
location of the tumor.


====Contraindicated medications====
====Contraindicated medications====
Line 137: Line 29:


|MedCond = Cerebral neoplasm|Streptokinase}}
|MedCond = Cerebral neoplasm|Streptokinase}}
===Radiation Therapy===
In case of a malignant brain tumor, radiation therapy is needed to control the tumor and possibly acheive long-term remission.
There are some possible side effects of radiation therapy; these include the possibility of strokes and [[dementia]]. The severity as well as the chance that they happen, worsen with higher doses of therapy. The radiation therapy is usually very well tolerated.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Needs content]]
{{WH}}
[[Category:Primary care]]
{{WS}}
 
[[Category:Disease]]
[[Category:Disease]]
[[Category:Brain]]
[[Category:Brain]]
[[Category:Neurology]]
[[Category:Neurology]]
 
[[Category:Up-To-Date]]
{{WH}}
[[Category:Oncology]]
{{WS}}
[[Category:Medicine]]
[[Category:Neurosurgery]]

Latest revision as of 20:41, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Brain tumor Microchapters

Patient Information

Overview

Classification

Adult brain tumors
Glioblastoma multiforme
Oligodendroglioma
Meningioma
Hemangioblastoma
Pituitary adenoma
Schwannoma
Primary CNS lymphoma
Childhood brain tumors
Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Craniopharyngioma
Pinealoma
Metastasis
Lung cancer
Breast cancer
Melanoma
Gastrointestinal tract cancer
Renal cell carcinoma
Osteoblastoma
Head and neck cancer
Neuroblastoma
Lymphoma
Prostate cancer

Causes

Differentiating Brain Tumor from other Diseases

Overview

The predominant therapy for brain tumor is surgical resection. Adjunctive chemotherapy and radiation may be required.

Medical Therapy

Some drugs that are used to treat brain cancer are:

  • Lomustine- FDA approved - used in patients who have already had surgery or radiation therapy
  • Temozolomide- FDA approved - used in adults for the treatment of Anaplatic astrocytomas and Glioblastoma multiforme

Other medications used to treat primary brain tumors in children may include:

  • Corticosteroids, such as dexamethasone, to reduce brain swelling
  • Medicines such as urea or mannitol to reduce brain swelling and pressure
  • Anticonvulsants, such as evetiracetam (Keppra), to reduce seizures
  • Pain medications
  • Antacids or histamine blockers to control

Contraindicated medications

Cerebral neoplasm is considered an absolute contraindication to the use of the following medications:

Radiation Therapy

In case of a malignant brain tumor, radiation therapy is needed to control the tumor and possibly acheive long-term remission. There are some possible side effects of radiation therapy; these include the possibility of strokes and dementia. The severity as well as the chance that they happen, worsen with higher doses of therapy. The radiation therapy is usually very well tolerated.

References

Template:WH Template:WS