Brain and spinal cord cancers

Treatment

The Fred Hutchinson Cancer Center Brain and Spine Metastases Clinic offers the most advanced treatment options to patients who have cancer that has metastasized to the brain or spinal cord. Our treatments are based on the latest available scientific evidence and clinical research.

Our goals for managing brain and spinal cord metastases are to:

Remove or destroy the cancer through surgery, radiation and/or chemotherapy
Relieve symptoms that are caused by a tumor pressing on the brain or spinal cord
Improve the patient’s overall functioning and quality of life

The type of treatment we recommend for you will depend on several factors, including the type of cancer you have, its location, your overall health and your individual wants and goals.

Treatment options may involve one or more of the following:

Palliative care

Supportive and palliative care is specialized medicine for people who have a life-limiting or life-threatening condition. It is an additional layer of support for those with a serious illness.

The palliative care team plays a central role within cancer care at Fred Hutch and within the Neuro-Oncology Clinic at Fred Hutch.

Palliative care

Supportive and palliative care is specialized medicine for people who have a life-limiting or life-threatening condition. It is an additional layer of support for those with a serious illness.

Proton therapy

Although Fred Hutch's Brain and Spine Metastases Clinic treats mainly brain and spine metastases, we use proton therapy to treat many types of primary, secondary and metastasized brain and central nervous system tumors at our proton therapy facility.

Brain tumors most appropriate for proton therapy

Tumors of the brain may be benign (non-cancerous) or malignant (cancerous). Benign brain tumors need to be treated because they can cause serious health problems by pressing on sensitive areas of the brain. Additionally, some benign tumors can become malignant over time. Malignant tumors are classified as brain cancer when they originate in the brain. Because the brain is so complex, treatment to this area might have long-term implications to the nervous system or other organs. If you or someone you love has been diagnosed with a brain tumor, we recommend learning about all your treatment options before making a decision.

Advantages of proton therapy for brain tumors over standard X-ray radiation

Too much radiation to the brain has been known to cause neurological dysfunction. Compared with X-ray radiation therapy, proton therapy for brain tumors results in less exposure to normal brain tissue, eyes, optic nerves, and pituitary gland. This is because protons precisely target a tumor and do not continue beyond it the way X-rays do. Less healthy brain tissue is irradiated with proton therapy than with X-ray/IMRT, therefore patients experience fewer side effects.

Benign Not cancer. Benign tumors may grow larger but do not spread to other parts of the body. Nonmalignant Not cancer. Nonmalignant tumors may grow larger but do not spread to other parts of the body. Also called benign. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Compared to other forms of radiation therapy, proton therapy (right, above) delivers less radiation to normal brain tissue. The extra exposure to healthy tissue that X-rays/IMRT deliver can be as much as getting 75,000 to 450,000 dental X-rays. This additional radiation increases the risk of side effects. Compared with X-ray radiation therapy, proton therapy results in less exposure to normal brain tissue, eyes, optic nerves, and pituitary gland.

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Proton Therapy Treatment for Brain Tumors

Proton therapy

Compared with X-ray radiation therapy, proton therapy for brain tumors results in less exposure to normal brain tissue, eyes, optic nerves, and pituitary gland. This is because protons precisely target a tumor and do not continue beyond it the way X-rays do.

Radiation

There are different types of radiation therapy that can be used to treat brain metastases. Depending on how much the disease has spread, this treatment may be able to either stop or slow the growth of brain metastases. Radiation therapy may be used alone or along with other treatments, like surgery or systemic therapies.

The different types of radiation therapy are:

Gamma knife radiosurgery, a noninvasive or minimally invasive outpatient treatment for some patients with conditions that would typically require brain surgery or whole-brain radiation
Whole-brain radiation therapy, which is most often used for multiple brain tumors
Focused radiation therapy, which targets the tumor and immediate surrounding areas
Intensity-modulated radiotherapy (IMRT), which allows radiation to be more exactly shaped to fit the tumor

Before radiation treatment begins, your radiation oncologist will use an imaging technique such as an MRI, CT scan, PET scan, angiography or a SPECT scan to find out where you need radiation.

Your neuro-oncologist will discuss treatment options with you, which may include radiation therapy.

Proton therapy

Proton therapy is an advanced therapy and an important alternative to conventional radiation for many types of cancer (and some noncancerous tumors).

Brain tumors are frequently located close to critical structures. The advantage of using protons to treat this cancer is that doctors can target high doses of radiation at the cancer with the goal of minimizing radiation to healthy tissues. This may reduce side effects. Fred Hutchinson Cancer Center – Proton Therapy is the only facility in a seven-state region to offer this treatment.

Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Neuro-oncologist A physician who has special training in diagnosing and treating brain tumors and other tumors of the nervous system. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. PET (positron emission tomography) scan A procedure in which a small amount of radioactive glucose is injected into a vein, and a scanner is used to make detailed pictures of areas inside the body in order to find cancer cells. A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Radiation

Systemic therapies

Systemic therapies, such as chemotherapy and immunotherapy, use medication to attack fast-growing cancer cells or to stop the cells from dividing.

Chemotherapy can play an important role in treating brain metastases. They are often given by infusion, through lumbar puncture (spinal tap) or through a special port called an Ommaya reservoir that delivers medication directly to the brain.
Immunotherapy uses parts of the body’s own immune system to fight cancer. It can be used on its own as a treatment or in coordination with other treatments like traditional chemotherapy, surgery and/or radiation.
Targeted therapy blocks the growth of cancer cells by using drugs that interfere with growth signals in cancer cells.

Your neuro-oncologist will discuss treatment options with you, which may include systemic therapy.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Infusion An injection of medications or fluids into a vein over a period of time. Lumbar puncture A procedure in which a thin needle called a spinal needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give drugs. Also called spinal tap. Neuro-oncologist A physician who has special training in diagnosing and treating brain tumors and other tumors of the nervous system. Systemic therapy Treatment using substances that travel through the bloodstream, reaching and affecting cells all over the body. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.

Systemic therapies

Systemic therapies, such as chemotherapy and immunotherapy, use medication to attack fast-growing cancer cells or to stop the cells from dividing.

Surgery

Surgery may be a treatment option for your brain metastases, depending on the number of masses, size and location. Your symptoms may also help to define if surgery is the best treatment for you. Surgery is often used for single, large brain metastases.

Our neurosurgeons are specially trained on procedures related to brain metastases and offer some treatments using endoscopy. Endoscopy is a minimally invasive technique that uses small incisions and an endoscope (a thin, flexible, lighted tube) to see and remove the cancer. There is often less injury to other surrounding tissue with endoscopy, and recovery can be faster compared to traditional surgery.

Regardless of how much cancer is removed by surgery, radiation therapy and/or chemotherapy may also be used as part of your treatment. Your neuro-oncologist will work closely with your surgeon and radiation team.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Endoscopy A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Neuro-oncologist A physician who has special training in diagnosing and treating brain tumors and other tumors of the nervous system. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Surgery

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