New treatments for brain tumors are in development. How to choose the right combination of surgery, radiotherapy and chemotherapy therapy for brain tumors? Leading brain tumor neurosurgeon reviews key decisions to make. Brain tumor treatment options are many today. Dr. Anton Titov, MD. There are several methods of brain cancer therapy. They are used together with neurosurgery. How do you treat patients with brain tumors? Dr. Anton Titov, MD. How to achieve the best results of brain tumor therapy? Dr. Mika Niemela, MD. Yes. First we take a look at the brain tumor symptoms. Then MRI. MRI is the key diagnostic test. Let’s we talk about adults and let’s we talk about brain tumors, not cerebellar tumors. You can reliably say from brain MRI, in most of the cases, whether a brain tumor is benign or malignant. That kind of tumor diagnosis divides the patient into groups. Dr. Mika Niemela, MD. Because in benign tumors you don't necessarily need other treatment except surgery. Let’s talk about malignant brain tumors. Then you have to think about radiation treatment [radiotherapy]. Dr. Anton Titov, MD. You also have to use chemotherapy after surgery. Then we do combined treatment in malignant brain tumors cases. Dr. Mika Niemela, MD. We have all the brain tumor treatment options available here. There is a lot of research going on at University of Helsinki. You collaborate internationally on experimental methods of brain tumor treatment. You have clinical trials for the post-operative treatment of brain tumors. Yes. There has been a lot of progress over the recent 5-10 years in the prognosis of malignant brain tumors. Brain cancer treatment prognosis improved due to effective chemotherapy. Temozolomide has been a fantastic medication. Because patients can take it orally. Temozolomide has very small side effects. Dr. Mika Niemela, MD. Patients are doing well. The prognosis for glioblastoma survival has almost doubled in these very malignant tumors [gliomas / glioblastomas]. Dr. Anton Titov, MD. Are you aware of any other additional chemotherapy options for malignant brain tumors? New therapy methods may be in the research phase of development, in addition to Temozolomide. There are some bioactive drugs, immunotherapy that is being applied in melanoma treatment. Immunotherapy for brain tumors may happen. Dr. Mika Niemela, MD. But I'm not aware of any particular specific medication for malignant brain tumor treatment that is now under investigation. It is very important to underscore that the most important prognostic factor in brain tumor treatment remains the skill of the surgeon. Dr. Mika Niemela, MD. Exactly. The more you operate, the more experience you have to remove as much brain tumor as possible. Because it makes sense that the more you remove the tumor, the better the prognosis. Even if it's a malignant brain tumor. But it took a long time to show this result exactly scientifically. But that's how it is. Dr. Mika Niemela, MD. In benign brain tumors, it's natural that you have to remove everything if you want to cure the tumor. But in some skull base tumors it's safer to leave some tumor. Because skull base tumors tend to grow slowly. They don't threaten the life of the patient. Then you can add stereotactic radiotherapy if that brain tumor remnant grows later on.