Liquid Radiation After Brain Tumor Surgery
Another radiation treatment is the GliaSite radiation therapy system developed at Johns Hopkins. It delivers radiation from within the hole created by the surgical removal of a malignant brain tumor. GliaSite RTS is used for newly diagnosed, metastatic and recurrent brain tumors.
A few days after surgical removal of the tumor, liquid radiation is delivered to the edges of the tumor hole through a catheter . The liquid radiation targets places in and around the tumor site where cancer cells may remain. It delivers a precise amount of radiation for a few days. Then the catheter is removed.
Special Radiation Therapy Techniques
Radiation therapy can damage normal brain tissue, so doctors try to deliver high doses of radiation to the tumor with the lowest possible dose to normal surrounding brain areas. Several techniques can help doctors focus the radiation more precisely:
Three-dimensional conformal radiation therapy : 3D-CRT uses the results of imaging tests such as MRI and special computers to precisely map the location of the tumor. Several radiation beams are then shaped and aimed at the tumor from different directions. Each beam alone is fairly weak, which makes it less likely to damage normal tissues, but the beams join together at the tumor to give a higher dose of radiation there.
Intensity modulated radiation therapy : IMRT is an advanced form of 3D therapy. In addition to shaping the beams and aiming them at the tumor from several angles, the intensity of the beams can be adjusted to limit the dose reaching the most sensitive normal tissues. This may let the doctor deliver a higher dose to the tumor. Many major hospitals and cancer centers now use IMRT.
Stereotactic radiosurgery /stereotactic radiotherapy : This type of treatment delivers a large, precise radiation dose to the tumor area in a single session or in a few sessions . It may be useful for some tumors in parts of the brain or spinal cord that cant be treated with surgery or when a child isnt healthy enough for surgery.
SRS typically delivers the whole radiation dose in a single session, though it may be repeated if needed.
Radiation Therapy For Adult Brain And Spinal Cord Tumors
Radiation therapy uses high-energy rays or small particles to kill cancer cells. This type of treatment is given by a doctor called a radiation oncologist. Radiation therapy may be used in different situations:
- After surgery to try to kill any remaining tumor cells
- As the main treatment if surgery is not a good option and medicines are not effective
- To help prevent or relieve symptoms from the tumor
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If Youre Getting Radiation Therapy To The Breast
If you have radiation to the breast, it can affect your heart or lungs as well causing other side effects.
Short-term side effects
Radiation to the breast can cause:
- Skin irritation, dryness, and color changes
- Breast soreness
- Breast swelling from fluid build-up
To avoid irritating the skin around the breasts, try to go without wearing a bra. If this isnt possible, wear a soft cotton bra without underwires.
If your shoulders feel stiff, ask your cancer care team about exercises to keep your shoulder moving freely.
Breast soreness, color changes, and fluid build-up will most likely go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem, ask your cancer care team what steps you can take. See Lymphedema for more information.
Long-term changes to the breast
Radiation therapy may cause long-term changes in the breast. Your skin may be slightly darker, and pores may be larger and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before treatment. Sometimes the size of your breast changes it may become larger because of fluid build-up or smaller because of scar tissue. These side effects may last long after treatment.
After about a year, you shouldnt have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, tell your cancer care team about them right away.
Less common side effects in nearby areas
Side effects of brachytherapy
What Is Proton Therapy For Brain Tumors
Proton therapy is a high-energy beam that precisely targets tumor cells in the brain to destroy their DNA. Damaging the tumors DNA makes it difficult or impossible for the cells to multiply, which stops them from growing and can eventually shrink them.
Proton therapy uses proton particles, which can be set to travel a specific distance into the brain tumor before they stop. This makes it possible for doctors to target just the tumor while minimizing radiation dose to sensitive brain tissues and structures around it. The precision of proton therapy helps reduce potential damage to the brain caused by treatment, as well as helping reduce the risk of new cancers developing after radiation.
Besides brain tumors, proton therapy can also effectively treat other areas of the body and tumors in the spinal cord, which also require precise targeting due to their location.
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Treatment Outcomes For Select Histologies
Long-term survival after treatment of pediatric brain tumors is excellent at approximately 75% . Though pediatric brain tumors encompass a wide spectrum of histologies, those featured here are those most frequently encountered and commonly require radiotherapy as part of definitive management. Surgery and/or chemotherapy may also play a role depending on histology, patient age, and tumor location.
Targeted Therapy For Brain Cancer
Targeted therapies for brain cancer target specific pathways or abnormalities in brain tumor cells involved in tumor growth. Targeted therapy is often combined with other brain cancer treatments, such as chemotherapy. This treatment is often an option for patients who have a tumor recurrence after previous brain cancer treatments.
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How You Have Treatment
You have radiotherapy to the brain as a course of daily treatment sessions called fractions. It is likely to be 1 to 2 weeks of daily treatments. But this can vary.
You have a specialised CT planning scan so your treatment team can plan exactly where to give the radiotherapy. For this scan you will have a mould made. The mould helps to keep you in the right position and make sure that the treatment is delivered accurately each day. The treatment marks are placed on the mould instead of the skin.
To have the treatment you lie on a radiotherapy couch. The therapeutic radiographers help you to get into the right position. It is very important that you keep perfectly still. You will have your plastic mould or mask to wear to help with this.
While you are lying down, the plastic mould is put over your face and head and onto the radiotherapy couch. It makes sure that you dont move in the middle of your treatment.
Once you are in the correct position the radiographers then leave the room. This is so they are not exposed to the radiation. You will be alone for a few minutes while you have the treatment, but they can see and hear you the whole time.
It is important that you keep still and breathe normally. Sometimes there may be a delay in starting the radiotherapy. This is due to the radiographers taking an x-ray picture before treatment to check your position.
How Fertility Might Be Affected
For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.
Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.
See Fertility and Women With Cancer to learn more.
For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.
See Fertility and Men With Cancer to learn more.
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Radiotherapy For Brain Cancer Symptoms
When cancer has spread to the brain from elsewhere in the body, it is called a secondary brain tumour or a brain metastasis.
Cancer growing inside the brain increases pressure inside the skull. This can cause symptoms such as:
- increasing drowsiness
Radiotherapy is a common treatment for secondary brain tumours. It aims to shrink the cancer, relieve the pressure inside your skull, and reduce your symptoms.
Your doctor might suggest that you have radiotherapy to the whole of your brain. This is because it’s likely that there might be cancer elsewhere in the brain that is too small to show up on a scan.
After A Diagnosis Of Brain Cancer
After finding out you have brain cancer, you may feel shocked, upset, anxious or confused. These are normal responses. A diagnosis of brain cancer affects each person differently. For most it will be a difficult time, however some people manage to continue with their normal daily activities.
Your specialist will arrange for a range of health professionals to plan your treatment. This will be based on several factors including the type, size, location and genetic make-up of the cancer as well as, your age and general health, the types of symptoms you have and your needs and preferences.
Find out more about the best cancer care for brain cancer:
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Intensity Modulated Radiation Therapy
Doctors at NYU Langone may use intensity modulated radiation therapy to manage metastases. This approach involves delivering radiation from different directions to target the entire tumor. A machine called a linear accelerator delivers external beam radiation therapy to a tumor. The machine rotates around you during treatment.
Doctors break up the radiation into many small, computer-controlled beams of different adjustable strengths called fractions. Together, these mini-beams are sculpted in three dimensions to closely conform to the size, shape, and location of the cancerous tumor.
This approach may allow for higher doses of radiation therapy to treat the cancer, while better avoiding nearby healthy tissue. Treatment is delivered once daily, five days a week, for about six weeks.
Doctors may also use Gamma Knife radiosurgery at the same time to boost the effectiveness of external beam radiation therapy.
Minimally Invasive Surgical Techniques
Brain surgery is typically used to remove all the cancer cells, if possible. In the past, the surgeon would make large incisions to remove the tumor. Today, surgeons are often able to use more minimally invasive surgical techniques.
Where possible, endoscopy, which positions a camera next to the brain tumor, may allow for smaller surgical incisions to be used to perform a complete tumor resection. Potential advantages may include:
- Improved recovery time
- Lessened pain during the recovery process
- A quicker conclusion of cancer treatments
- A quicker return to normal activities
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If Youre Getting Radiation Therapy To The Brain
People with brain tumors often get stereotactic radiosurgery if the cancer is in only one or a few sites in the brain. Side effects depend on where the radiation is aimed. Some side effects might show up quickly, but others might not show up until 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call your doctor.
If the cancer is in many areas, sometimes the whole brain is treated with radiation. The side effects of whole brain radiation therapy may not be noticeable until a few weeks after treatment begins.
Radiation to the brain can cause these short-term side effects:
- Trouble with memory and speech
Some of these side effects can happen because radiation has caused the brain to swell. Medicines are usually given to prevent brain swelling, but its important to let your cancer care team know about headaches or any other symptoms. Treatment can affect each person differently, and you may not have these particular side effects.
Radiation to the brain can also have side effects that show up later usually from 6 months to many years after treatment ends. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function. You may also have an increased risk of having another tumor in the area, although this is not common.
Talk with your cancer care team about what to expect from your specific treatment plan.
Tips For Coping With Radiation Side Effects
Radiation side effects vary but can impact your quality of life. Here are some general ways you can manage your side effects at home:
- Prioritize getting plenty of rest.
- Eat a healthy and balanced diet.
- If you lose your taste or appetite, you may want to work with a dietician to develop a meal plan.
- Try to exercise regularly if youre able, though its not recommended that you start a new rigorous training program.
- Drink plenty of fluids.
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External Beam Radiation Therapy
There are several types of EBRT. The goal is to target the tumor and limit damage to nearby healthy brain cells. To limit the harm, your healthcare provider may use special types of EBRT such as:
Imaging tests will be done to see if the cancer has spread to other parts of your brain or spinal cord. If the cancer has spread, you may have radiation to your whole brain and spinal cord.
Studies On Proton Therapy In Brain & Spine Cancer
Our team has identified these studies as examples of the clinical benefits of proton therapy in brain & spine cancer.
A Prospective Phase II Randomized Trial of Proton Radiotherapy vs. Intensity Modulated Radiotherapy for Patients with Newly Diagnosed Glioblastoma
In this small randomized phase II clinical trial, patients with glioblastoma were randomly assigned to receive either x-ray or proton radiation delivered together with the drug temozolomide. Compared to those assigned to x-rays, patients treated with proton therapy had a statistically lower rate of fatigue and on average had fewer toxicities during treatment. The study was not designed to evaluate and did not show a difference in outcome, and there was no significant difference in the average time until patients experienced a cognitive decline. This may be related to the unfortunate poor prognosis of glioblastoma, and suggests patients with more favorable types of glioma with longer survival time may be more likely to benefit from proton therapy.
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Making Surgery Safer And More Accurate
Advanced brain mapping: Mapping the brain is critical for neurosurgeons who not only want to get a detailed fix on areas targeted for surgery but also need to minimize the risks of surgical damage to healthy brain regions that perform essential tasks. Never is this more critical than in the brain and spinal cord.
For many years, neurosurgeons have accomplished the job using a time-intensive approach called functional magnetic resonance imaging . Patients perform several simple taskssaying their name or moving an arm, for examplewhile their brain is repeatedly scanned. They have now discovered that resting state fMRI is as useful for precisely mapping all of an individual patients critical brain networks: speech, motor control and others in one 15-minute session while the patient lies in the scanner and rests.
Intraoperative MRI: With the data from the genetic tumor map and the functional MRI, the surgery can commence. However, as the tumor is removed and cerebrospinal fluid drained, the map becomes inaccurate for tumor margins. Thats where real-time intraoperative MRI comes in to give the surgeons the updated information to complete the surgery accurately. They have done well over 1000 iMRI cases, a significant portion of which are gliomas, pituitary skull base tumors, and spinal tumors, including metastases from lung and breast cancers.
Other Types Of Radiation Therapy
Brachytherapy : Unlike the external radiation approaches above, in brachytherapy a radiation source is put directly into or near the tumor. The radiation it gives off travels a very short distance, so it affects only the tumor. This technique is most often used along with external radiation. It provides a high dose of radiation at the tumor site, while the external radiation treats nearby areas with a lower dose.
Whole brain and spinal cord radiation therapy : If tests such as an MRI scan or lumbar puncture show the tumor has spread along the covering of the spinal cord or into the surrounding cerebrospinal fluid, then external radiation may be given to the whole brain and spinal cord. Some tumors such as ependymomas and medulloblastomas are more likely to spread this way, and therefore may require craniospinal radiation.
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What Happens During Radiotherapy For Brain Tumours
A lot of preparation happens before radiotherapy begins. Detailed scans are taken and the radiotherapy team carefully design the radiotherapy schedule and the shape of the target area. This area needs to be designed in three-dimensions, taking into account the need to ensure as little damage as possible to any areas of the brain that are crucial for the patient to function well, whilst killing as many cancer cells as possible.
Does Radiation Therapy Hurt
Radiation therapy itself is painless. You cant feel the radiation beams entering your body.
As patients progress through weeks of radiation therapy, however, they may begin to notice discomfort and skin redness at the delivery site. Be sure to speak to your care team about any side effects you may be experiencing, and they will help you with your symptoms.
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