Malignant brain tumors are aggressive cancerous growths that can significantly alter the lives of those diagnosed, requiring swift medical intervention and a combination of treatment approaches to manage symptoms, slow progression, and improve quality of life.

How Treatment Approaches Work Together to Fight Cancerous Brain Tumors

When someone receives a diagnosis of a malignant brain tumor, also called a brain cancer or malignant neoplasm of the brain, understanding what treatment options exist becomes critically important. These cancerous tumors grow rapidly and can invade surrounding healthy brain tissue, making them different from noncancerous or benign tumors. Treatment goals focus on removing or shrinking the tumor, controlling symptoms such as headaches and seizures, slowing disease progression, and helping patients maintain the best possible quality of life^[1][2].

The treatment journey is never identical for any two patients. What works for one person may not be appropriate for another because each brain tumor has unique characteristics. Factors such as the tumor’s location in the brain, its size, how quickly it grows, the specific type of cancer cells involved, and the patient’s overall health all influence which treatments doctors recommend. Additionally, the patient’s age and personal preferences play important roles in shaping the treatment plan^[3][10].

Medical societies and organizations have established standard treatment protocols based on years of research and clinical experience. These approved treatments form the backbone of care for most patients. At the same time, researchers around the world continue to investigate new therapies through clinical trials, offering hope for improved outcomes. Some of these experimental treatments target specific molecular pathways within cancer cells, while others harness the body’s immune system to fight the disease^[12][13].

Standard Treatment Methods for Malignant Brain Tumors

The foundation of treating malignant brain tumors typically begins with surgery. Neurosurgeons aim to remove as much of the tumor as possible while preserving surrounding brain tissue that controls important functions like movement, speech, and memory. The surgical procedure, called a craniotomy, involves removing a portion of the skull to access the brain. In some cases, surgeons use advanced imaging techniques during the operation to guide their work and maximize tumor removal while minimizing damage to healthy tissue^[8][11].

For certain tumor locations, surgeons may perform what is called awake brain surgery. During this procedure, the patient remains conscious under sedation so doctors can monitor brain function in real-time. This approach helps ensure that critical areas controlling speech, movement, or other vital functions are not damaged during tumor removal. Other surgical techniques include using lasers to destroy tumor tissue with heat, or employing minimally invasive methods through small incisions to reduce scarring and speed recovery^[11].

Following surgery, most patients with malignant brain tumors receive radiation therapy. This treatment uses high-energy beams, similar to X-rays but much stronger, to kill cancer cells or stop them from growing. Radiation works by damaging the genetic material inside cells, preventing them from dividing and spreading. The treatment is carefully planned to target the tumor area while sparing as much healthy brain tissue as possible^[9][14].

There are different types of radiation therapy. External beam radiation directs the energy from outside the body toward the tumor. A specialized form called proton therapy uses protons instead of X-rays, which allows for more precise targeting and potentially less damage to surrounding tissues. Radiation treatments typically occur five days per week over several weeks, with each session lasting only a few minutes. The total duration depends on the tumor type and treatment goals^[14].

Chemotherapy represents another cornerstone of standard treatment for malignant brain tumors. These are powerful drugs that kill rapidly dividing cancer cells throughout the body. The most commonly used chemotherapy drug for brain tumors is temozolomide, which patients typically take by mouth as a pill. This medication can cross from the bloodstream into the brain, which many other drugs cannot do because of a protective barrier around the brain called the blood-brain barrier^[12].

For glioblastoma, the most aggressive type of malignant brain tumor, the standard treatment combines surgery, radiation, and temozolomide. Patients usually begin taking temozolomide during radiation therapy and continue it for several months afterward. The typical schedule involves taking the drug daily for five days, followed by 23 days off, repeating this cycle for six months or longer depending on how well the treatment works and how the patient tolerates it^[12].

Chemotherapy affects not only cancer cells but also normal cells that divide quickly, such as those in hair follicles, the digestive tract, and bone marrow. This explains common side effects including nausea, vomiting, hair loss, fatigue, and increased risk of infections due to low blood cell counts. Doctors monitor blood counts regularly and can prescribe medications to manage nausea and other symptoms. Not everyone experiences all side effects, and their severity varies from person to person^[12].

Beyond these main treatments, patients often need additional medications to control symptoms caused by the tumor itself or by treatments. Many people require drugs called corticosteroids, such as dexamethasone, to reduce swelling around the tumor. This swelling, called edema, can cause headaches, confusion, and other neurological problems. Steroids work quickly to relieve these symptoms but can cause their own side effects if used long-term, including weight gain, mood changes, and elevated blood sugar^[9].

Seizures occur in many patients with brain tumors, so doctors frequently prescribe anti-seizure medications (also called anticonvulsants or antiepileptic drugs). These medications help prevent seizures by stabilizing electrical activity in the brain. Common examples include levetiracetam, phenytoin, and valproic acid. Finding the right medication and dose often requires adjustments, and patients need regular blood tests to monitor drug levels and watch for side effects^[9].

Innovative Treatments Being Tested in Clinical Trials

While standard treatments help many patients, researchers recognize that malignant brain tumors often recur despite aggressive treatment. This has driven intensive efforts to develop new therapies. Clinical trials offer access to these cutting-edge treatments before they become widely available. Understanding what these trials involve and what they’re testing can help patients make informed decisions about participation^[11][13].

Clinical trials proceed through phases, each with specific goals. Phase I trials test a new treatment’s safety in a small group of people, determining what dose can be given safely and identifying side effects. Phase II trials expand to more participants to evaluate whether the treatment actually works against the cancer and to gather more safety information. Phase III trials compare the new treatment to the current standard treatment in large groups of patients to determine which works better^[13].

One innovative approach being studied is called tumor-treating fields or TTFields. This technology uses electrical fields to disrupt cancer cell division. Patients wear a device with adhesive pads on their scalp that delivers low-intensity, alternating electrical fields to the brain. Unlike radiation, these fields don’t damage DNA but instead interfere with structures inside cells that are necessary for cell division. Studies have shown that when added to standard chemotherapy, TTFields can help some patients with glioblastoma live longer^[12].

TTFields devices need to be worn at least 18 hours per day to be effective, which requires significant commitment from patients. The most common side effects are skin irritation and discomfort where the adhesive pads contact the scalp. While this treatment doesn’t work for everyone, it represents a completely different approach to fighting brain cancer that doesn’t rely on drugs or radiation^[12].

Immunotherapy has revolutionized treatment for many cancers and is now being intensively studied for brain tumors. These treatments work by helping the patient’s own immune system recognize and attack cancer cells. Normally, the immune system doesn’t easily access the brain, and brain tumors have developed ways to hide from immune cells. Immunotherapy tries to overcome these obstacles through various strategies^[11][12].

One type of immunotherapy being tested uses drugs called checkpoint inhibitors. Cancer cells can activate “checkpoint” proteins that tell immune cells to leave them alone. Checkpoint inhibitor drugs block these signals, allowing immune cells to attack the tumor. Examples include medications targeting proteins called PD-1, PD-L1, and CTLA-4. While these drugs have shown remarkable success in treating melanoma and lung cancer, results in brain tumors have been more modest, and research continues^[12].

Vaccine therapy represents another immunotherapy approach being studied in clinical trials. Unlike vaccines that prevent infectious diseases, cancer vaccines aim to treat existing tumors by training the immune system to recognize tumor-specific features. Some trials are testing vaccines made from the patient’s own tumor cells, while others use synthetic compounds that mimic tumor proteins. Although this approach is still experimental, some patients have shown encouraging responses^[12].

Scientists have also discovered that malignant brain tumors contain specific genetic mutations and molecular changes that differ from normal brain cells. This understanding has led to development of targeted therapies that attack cancer cells based on these molecular characteristics. For example, some brain tumors have changes in genes called IDH1 and IDH2. Clinical trials are testing drugs specifically designed to target tumors with these mutations^[12][13].

Another molecular target is a protein called EGFR (epidermal growth factor receptor), which is amplified or mutated in many glioblastomas. EGFR helps cancer cells grow and divide, so blocking it might slow tumor growth. Several drugs targeting EGFR are being tested, though results so far have been mixed. Researchers are working to understand why some tumors respond while others don’t, which may lead to better patient selection for these treatments^[12].

The TERT promoter and changes in chromosome 7 and 10 represent other molecular features that researchers are studying. Identifying these characteristics through genetic testing of tumor tissue helps doctors classify tumors more precisely and may guide treatment choices. Some clinical trials only accept patients whose tumors have specific molecular features, making genetic testing increasingly important in brain tumor care^[7][12].

Anti-angiogenesis drugs work by cutting off the blood supply that tumors need to grow. Brain tumors, particularly glioblastomas, form new blood vessels to nourish themselves as they expand. A drug called bevacizumab blocks a protein called VEGF (vascular endothelial growth factor) that tumors use to create new blood vessels. This medication is already approved for treating recurrent glioblastoma and is being studied in combination with other treatments for newly diagnosed tumors^[11].

Clinical trials for brain tumors are being conducted at major medical centers throughout the United States, Europe, and other regions around the world. To participate, patients typically need to meet specific eligibility criteria, which might include the tumor type and grade, previous treatments received, overall health status, and molecular characteristics of the tumor. Doctors can help patients search for appropriate trials and determine if enrollment might be beneficial^[13][14].

Most Common Treatment Methods

• Surgery
  • Craniotomy to remove as much tumor as possible while preserving brain function
  • Awake brain surgery to monitor function during tumor removal
  • MRI-guided laser ablation using heat to destroy tumor tissue
  • Minimally invasive approaches through small incisions
• Radiation Therapy
  • External beam radiation targeting the tumor from outside the body
  • Proton therapy using protons for more precise targeting
  • Typical schedule of daily treatments over several weeks
• Chemotherapy
  • Temozolomide taken orally, often combined with radiation
  • Treatment cycles continuing for six months or longer
  • Regular monitoring for side effects and blood count changes
• Targeted Therapy
  • Drugs targeting specific molecular changes like IDH mutations
  • EGFR inhibitors for tumors with amplification of this protein
  • Bevacizumab to block new blood vessel formation
• Immunotherapy
  • Checkpoint inhibitors to help immune cells attack tumors
  • Cancer vaccines to train the immune system
  • Experimental approaches still being studied in clinical trials
• Tumor-Treating Fields
  • Wearable device delivering electrical fields to disrupt cell division
  • Used in combination with chemotherapy for glioblastoma
  • Requires wearing device at least 18 hours daily
• Supportive Medications
  • Corticosteroids to reduce brain swelling and control symptoms
  • Anti-seizure drugs to prevent or control seizures
  • Pain medications and drugs to manage nausea and other side effects