Optimizing Brain Tumor Treatment: A Guide to Surgery, Radiation, and Chemotherapy

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• Brain Tumor Diagnosis with MRI
• Treatment for Benign Brain Tumors
• Combined Therapy for Malignant Tumors
• Advances in Brain Cancer Chemotherapy
• Surgical Skill and Prognosis
• Skull Base Tumor Management
• Full Transcript

Brain Tumor Diagnosis with MRI

Dr. Mika Niemela, MD, identifies MRI as the key diagnostic test for brain tumors. He explains to Dr. Anton Titov, MD, that an MRI can reliably determine if a tumor is benign or malignant in most adult cases. This initial diagnosis is crucial as it immediately divides patients into different treatment pathways. The information from the MRI scan forms the foundation for all subsequent therapeutic decisions.

Treatment for Benign Brain Tumors

For patients with a benign brain tumor diagnosis, surgery is often the sole required treatment. Dr. Mika Niemela, MD, clarifies that these tumors may not necessitate additional therapies like radiotherapy or chemotherapy if completely resected. The goal for benign tumors is a complete surgical removal to achieve a cure. This approach highlights the importance of an accurate initial diagnosis from the MRI.

Combined Therapy for Malignant Tumors

Malignant brain tumor treatment requires a multimodal approach. Dr. Mika Niemela, MD, emphasizes that a combination of surgery, radiotherapy, and chemotherapy is essential. He discusses this strategy with Dr. Anton Titov, MD, noting that all these treatment options are available and routinely used. This combined modality therapy is the standard of care for aggressive brain cancers like glioblastoma, aiming to improve survival outcomes.

Advances in Brain Cancer Chemotherapy

Significant progress in brain cancer prognosis has been made over the last 5-10 years. Dr. Mika Niemela, MD, credits the oral chemotherapy drug Temozolomide for this improvement. He tells Dr. Anton Titov, MD, that Temozolomide is a fantastic medication with very small side effects, which patients tolerate well. Its effectiveness has nearly doubled the survival prognosis for patients with very malignant glioblastomas.

Surgical Skill and Prognosis

The surgeon's experience is the most important prognostic factor in brain tumor treatment. Dr. Mika Niemela, MD, states that the more a surgeon operates, the more tumor they can safely remove. He explains to Dr. Anton Titov, MD, that extensive tumor removal leads to a better prognosis, even for malignant tumors. This principle, now scientifically proven, underscores the critical value of seeking care from a highly experienced neurosurgeon.

Skull Base Tumor Management

Management strategies differ for tumors located at the skull base. Dr. Mika Niemela, MD, notes that in these cases, it is sometimes safer to leave a small amount of tumor behind to avoid damaging critical neural structures. These tumors often grow slowly and may not immediately threaten the patient's life. If a remnant does grow, Dr. Mika Niemela, MD, explains that stereotactic radiotherapy can be added as a highly precise secondary treatment.

Full Transcript

Dr. Anton Titov, MD: New treatments for brain tumors are in development. How to choose the right combination of surgery, radiotherapy, and chemotherapy for brain tumors? A 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 an MRI. MRI is the key diagnostic test. Let's talk about adults and let's talk about brain tumors, not cerebellar tumors.

You can reliably say from a brain MRI, in most 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.

Dr. Anton Titov, MD: You also have to use chemotherapy after surgery.

Dr. Mika Niemela, MD: Then we do combined treatment in malignant brain tumor cases. We have all the brain tumor treatment options available here. There is a lot of research going on at the University of Helsinki. You collaborate internationally on experimental methods of brain tumor treatment.

You have clinical trials for the postoperative treatment of brain tumors.

Dr. Mika Niemela, MD: Yes. There has been a lot of progress over the recent 5 to 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.

Patients are doing well. The prognosis for glioblastoma survival has almost doubled in these very malignant tumors.

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.

Dr. Mika Niemela, MD: There are some bioactive drugs, immunotherapy that is being applied in melanoma treatment. Immunotherapy for brain tumors may happen. 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.