Understanding Brain Cancer Treatment: Surgery, Radiation, Chemotherapy, and Emerging Options

Brain tumors can be primary or metastatic and range from slow-growing to aggressive. Modern care uses molecular profiling to guide decisions. Treatment commonly combines maximal safe surgery, radiation (including stereotactic techniques), systemic therapies such as temozolomide or targeted agents, and supportive measures like corticosteroids. Multidisciplinary teams and clinical trials are important for personalized treatment.

What is brain cancer?

Brain tumors arise from cells in the central nervous system (primary brain tumors) or spread to the brain from cancers elsewhere (metastatic brain tumors). Primary tumors range from slow-growing (often called "benign") to aggressive malignant types such as high-grade gliomas. Modern classification relies on histology plus molecular markers (for example, IDH mutation status and 1p/19q codeletion) to guide prognosis and treatment.

Common symptoms

Symptoms reflect a tumor's location and effect on intracranial pressure. Patients may experience headache, nausea or vomiting, seizures, cognitive or personality changes, weakness, or focal neurologic deficits. Acute decline or coma can occur if swelling or bleeding increases intracranial pressure.

Goals of treatment

Treatment aims to remove or reduce tumor burden, control symptoms, preserve neurologic function, and prolong quality-adjusted survival. For metastatic disease, treating systemic cancer is also essential.

Surgery

Neurosurgery is often the first step for accessible tumors. Surgeons aim for maximal safe resection: removing as much tumor as possible while preserving critical brain functions. When a lesion is uncertain, surgeons obtain tissue for pathology and molecular testing. Some tumors are not safely resectable; in those cases, biopsy or partial debulking is used to guide further therapy.

Radiation therapy

Radiation kills or controls tumor cells and is used after surgery, for unresectable tumors, and to treat metastases. Options include conventional fractionated radiotherapy and focused stereotactic radiosurgery (SRS) - delivered as a single high-dose session or a few fractions (examples include Gamma Knife or linear accelerator-based SRS). Proton therapy offers a more targeted dose distribution for selected patients.

Systemic therapies

Chemotherapy and targeted drugs depend on tumor type. For many high-grade gliomas, temozolomide is a standard drug given with radiation for newly diagnosed disease; molecular markers (for example, MGMT promoter methylation) can predict benefit. Targeted therapies, immune checkpoint inhibitors, and other agents are used selectively or in clinical trials.

An additional device-based therapy, tumor treating fields (TTFields), is approved for certain gliomas and may be offered as part of multimodal care.

Supportive care and side effects

Corticosteroids (commonly dexamethasone) reduce tumor-related swelling and improve symptoms. Antiepileptic drugs are used for seizures but not routinely as long-term prophylaxis without seizures. Common side effects across treatments include fatigue, nausea, hair loss (localized with radiation), and blood-count changes. Multidisciplinary teams include neurosurgeons, neuro-oncologists, radiation oncologists, neuroradiologists, rehabilitation therapists, and palliative care providers.

Clinical trials and personalized care

Molecular profiling of tumors increasingly directs treatment choices and eligibility for clinical trials. Patients should discuss trial options and the goals of care with their team.

Key takeaways

Treatment combines surgery, radiation, systemic therapy, and supportive care tailored to tumor type, molecular features, location, and patient goals. A multidisciplinary approach and access to specialized centers improve the range of available options.