If you have a malignant brain tumour, you'll usually need surgery to remove as much of the tumour as possible. Radiotherapy, chemotherapy or both are then used to treat any remaining tumour tissue.

However, most malignant brain tumours return after they have been treated. At this point, the aim of treatment is to extend life for as long as possible and treat any symptoms. 

This page explains the treatment options for both primary and secondary brain tumours (those that started in the brain and those that spread to the brain from elsewhere in the body).

Your healthcare team

Many hospitals use multidisciplinary teams (MDTs) to treat brain tumours. These are teams of specialists who work together to decide about the best way to proceed with your treatment.

Your team may include:

• a neurosurgeon, who will operate on your brain
• a neurologist, who will treat illness caused by the tumour and manage your chemotherapy, if necessary
• an oncologist, who will administer radiotherapy and chemotherapy
• a specialist nurse, who will give you information and support

You should be given the name and contact details of a key worker, who will support you during your brain tumour treatment. 

Choosing a treatment

Deciding on the treatment that's best for you can often be confusing. Your team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you'd like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Primary tumours

Surgery

Most primary tumours will be removed using surgery. They will then usually be treated with radiotherapy, chemotherapy or both afterwards (see below), to reduce the risk of the tumour coming back. 

Surgery aims to remove as much of the tumour as possible, without damaging surrounding tissue.

You are given a general anaesthetic (put to sleep) and an area of your scalp is shaved. A section of the skull is cut out as a flap to reveal the brain and tumour underneath. This is known as a craniotomy. The surgeon can then remove the tumour.

You may then be given photodynamic therapy, where the surgeon injects a light-sensitive drug into your veins, which is taken up by the remaining cancer cells. When a laser is focused on these cancer cells, the drug becomes active and kills them.

Chemotherapy and radiotherapy

Some tumours situated deep inside the brain are difficult to remove without damaging surrounding tissue. In this case, the tumour may just be treated with chemotherapy, radiotherapy or both.

During radiotherapy, a dose of high-energy radiation is focused on the tumour to stop the cancer cells multiplying. The radiation is a lower intensity than that used in radiosurgery (see below), and is given over a period of time.

Chemotherapy is medication used to kill any cancerous cells, and may be given as tablets, an injection or implants. Carmustine and temozolomide are both chemotherapy drugs used in the treatment of high-grade brain tumours, and are described below.

Carmustine implants are small wafers placed at the tumour site when the tissue has been surgically removed. As they dissolve, they release carmustine to slow or stop growth of cancerous cells.

Carmustine implants may be used to treat gliomas in an advanced stage of growth. In 2007, the National Institute for Health and Care Excellence (NICE) issued guidelines on the use of Carmustine implants to treat gliomas. NICE has approved them as treatment for newly diagnosed malignant gliomas, but only where 90% or more of the tumour has been surgically removed.

Carmustine implants need to be implanted immediately following surgery and before surgery is complete. This means your surgical team must be prepared to use them in advance if the removal of 90% of the tumour looks possible.

Possible side effects of carmustine implants are brain oedema (fluid in the brain), seizures and infection in the brain.

Temozolomide is a chemotherapy drug given to some patients with a malignant glioma to slow down progression after initial treatment, or if the tumour has returned.

Possible side effects of temozolomide include anorexia, constipation, fatigue, headache, nausea and vomiting.

Read more in the 2001 NICE guidelines on Temozolomide for recurrent malignant glioma.

Radiosurgery

Radiosurgery involves focusing a high-energy dose of radiation on the tumour to kill it. It is different to radiotherapy in that the radiation is:

• a higher intensity
• focused on a smaller area of the brain
• given in one session (rather than over a period of time)

This means you will usually not experience any of the usual side effects of radiotherapy, such as skin reddening and hair loss. Recovery is good and an overnight stay is usually not required.

However, radiosurgery is only available in a few specialised centres across the UK and is only suitable for a selected group of people, based on the characteristics of their tumour.

Secondary tumours

A secondary brain tumour indicates serious, widespread cancer that usually cannot be cured. Treatment aims to improve symptoms and prolong life by shrinking and controlling the tumour. Treatment may include:

• corticosteroids, which are tablets to reduce swelling and pressure in the brain
• chemotherapy and radiotherapy (see above)
• anticonvulsant medicines, which prevent epileptic fits
• painkillers to reduce headaches
• anti-nausea drugs, which can help relieve sickness caused by increased pressure inside the skull

What if I choose not to have treatment?

If your tumour is at an advanced stage or in a difficult place in the brain, a cure may not be possible and treatment may only be able to control the cancer for a period of time. This means you will be getting the side effects of treatment without getting rid of the tumour.

In this situation it may be difficult to decide whether or not to go ahead with treatment. Talk to your doctor about what will happen if you choose not to be treated, so you can make an informed decision.

If you decide not to have treatment, you will still be given palliative care, which will control your symptoms and make you as comfortable as possible.