Taking Stock Of Your Options

New technology has helped expand physicians’ choices for treating benign and malignant brain tumors

In the field of neuro-oncology, precision and accuracy are of paramount importance, and the perfecting of those qualities has been the catalyst for many of the field’s greatest technological advances. Yet according to neuro-surgeon Fremont P. Wirth, MD, Medical Director for the Neuro-Oncology Center at the Nancy N. and J.C. Lewis Cancer & Research Pavilion (LCRP), steadfast rigidity is only for the tools of treatment, not the approach.

“There are no absolute rules,” Wirth says. “Much of the treatment depends on the physician’s judgment on the best option to take.”

Luckily for patients facing a brain tumor diagnosis, there are now more treatment options available than ever before. Dr. Wirth provided Smart Living with answers about some of the more common benign and malignant tumors and what can be done to treat them.

Benign Tumors

Benign tumors grow slowly and are not always harmful, but some can cause symptoms depending on their size and location.

“One common benign tumor is an meningioma, which tends to grow on the covering of the brain,” Wirth says. “If it was a fairly small tumor, we might elect to not to treat with surgery, especially for a patient in their 70s or 80s, where the risk of surgery and anesthesia is greater.

We would do a follow-up scan in 6 or 12 months. If it showed no change, our plan would simply be to continue watching it. “

“If the benign tumor is large, or if it is symptomatic in a younger patient, we frequently will recommend removing it,” Wirth says. Symptoms of benign tumors can include seizures, weakness in the legs or arms, headaches, or vision impairment.

“Some benign tumors occur around the base of the brain, where there are a lot of cranial nerves and large blood vessels,” Wirth says. “In certain cases, we might elect to remove only part of the tumor, and then use stereotactic radiation with the CyberKnife technology.”

The CyberKnife is the highly-advanced robotic radiation technology at the LCRP. It provides a non-invasive procedure that delivers high doses of radiation with sub-millimeter accuracy, minimizing damage to the healthy surrounding tissue.

“One example in which the CyberKnife would be a better alternative to surgery is if we found a tumor in the nerve for hearing, called the eighth nerve, and it was relatively small,” Wirth says.

There are cases in which the size or location of a tumor makes surgery the best possible option.

“An example would be a benign tumor in the pituitary gland, very close to the optic nerves, which are susceptible to radiation injury,” Wirth says.

Malignant Tumors

Malignant tumors are made of up cancerous cells. Many of these have the ability to metastasize, or spread to the brain from other sites in the body.

“A common malignant primary brain tumor is called a glioma,” Wirth explains. “These occur inside the brain rather than the surface, and are usually treated with surgery.”

“Some of these tumors are not optimal for treatment with CyberKnife because they are so diffuse, or spread out over a wide area,” Wirth says. “And again, an older person might have more risk than benefit from surgery. In that case, we might elect to do a biopsy, which would guide us toward the best treatment option, such as chemotherapy or radiation therapy.”

The other common malignant tumor is the metastatic tumor, meaning that it has spread from another part of the body to the brain.

“Depending on the size, location, and the number of metastases, these tumors might be treated with surgery or with the CyberKnife, or some combination of the two,” Wirth says.

Greater Options

“One shoe doesn’t fit everybody, and everybody is not a candidate for surgical removal of tumors,” Wirth says. “But the options are much greater than they were years ago.”

Dr. Wirth consults with physicians in radiation oncology and medical oncology to devise the best plan for each patient. He and his colleagues agree that advances in MRI and CT-scan imaging, as well as tools like the CyberKnife, are making a huge impact in neuro-oncology and patient care.

“The new technology helps us tailor a patient’s treatment to their particular tumor biology and location,” Wirth says, “and that makes outcomes much better.” 
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