
Brain tumors are usually treated with surgery, radiation therapy, and/or chemotherapy. Depending on the patient's needs, several methods may be used. The patient may be referred to doctors who specialize in different kinds of treatment and work together as a team. This medical team often includes a neurosurgeon, a medical oncologist, a radiation oncologist, a nurse, a dietitian, and a social worker. The patient may also work with a physical therapist, an occupational therapist, and a speech therapist.

Before treatment begins, most patients are given steroids, which are drugs that relieve swelling (edema). They may also be given anticonvulsant medicine to prevent or control seizures. If hydrocephalus is present, the patient may need a shunt to drain the cerebrospinal fluid. 

As always with leiomyosarcoma, surgical resection is the treatment of choice.  Direct neurosurgical excision, with or without other treatments, is usually recommended if it is possible.  Surgery is the usual treatment for most brain tumors. To remove a brain tumor, a neurosurgeon makes an opening in the skull. This operation is called a craniotomy. Whenever possible, the surgeon attempts to remove the entire tumor. However, if the tumor cannot be completely removed without damaging vital brain tissue, the doctor removes as much of the tumor as possible. Partial removal (debulking) helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy.

Radiation in some form  [intraoperative, whole brain irradiation, stereotactic or gamma knife, proton or other particle beam, or radioisotope insertion] is often used alone or in conjunction with surgery or possibly other treatments.  Cognitive defects may occur after whole brain irradiation, and possibly with other treatments.  Radionecrosis of the brain-the development of multiple and increasing areas of dead and dying brain tissue-is a serious complication of radiation treatment. 
Radiation therapy is the use of high-powered rays to damage cancer cells and stop them from growing. It is often used to destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery. Radiation therapy is also used when surgery is not possible.

Radiation therapy may be given in two ways. External radiation comes from a large machine. Generally, external radiation treatments are given 5 days a week for several weeks. The treatment schedule depends on the type and size of the tumor and the age of the patient. Giving the total dose of radiation over an extended period helps to protect healthy tissue in the area of the tumor.

Radiation can also come from radioactive material placed directly in the tumor (implant radiation therapy). Depending on the material used, the implant may be left in the brain for a short time or permanently. Implants lose a little radioactivity each day. The patient stays in the hospital for several days while the radiation is most active.

External radiation may be directed just to the tumor and the tissue close to it or, less often, to the entire brain. (Sometimes the radiation is also directed to the spinal cord.) When the whole brain is treated, the patient often receives an extra dose of radiation to the area of the tumor. This boost can come from external radiation or from an implant.

Stereotactic radiosurgery is another way to treat brain tumors. Doctors use the techniques described in the Surgery section to pinpoint the exact location of the tumor. Treatment is given in just one session; high-energy rays are aimed at the tumor from many angles. In this way, a high dose of radiation reaches the tumor without other brain tissue becoming badly damaged. 

Chemotherapy is the use of drugs to kill cancer cells. The doctor may use just one drug or a combination, usually giving the drugs by mouth or by injection into a blood vessel or muscle. Intrathecal chemotherapy involves injecting the drugs into the cerebrospinal fluid.

Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another cycle. Patients often do not need to stay in the hospital for treatment. Most drugs can be given in the doctor's office or the outpatient clinic of a hospital. However, depending on the drugs used, the way they are given, and the patient's general health, a short hospital stay may be necessary.

Chemotherapy is not very successful in treating brain tumors, because of something called the "blood brain barrier" [BBB], which prevents chemotherapy agents, present in the blood, from migrating into or penetrating brain tissue.  There are substances and conditions that do break down the BBB, and allow permeation of the brain, but these are in experimental use at this time.  We do know that trauma and radiation and certain substances can cause disruption of the BBB.  [3,4,6] Were chemotherapy agents able to pass the blood brain barrier, would their neurotoxicity become the limiting factor for treatment? [5]

Radio frequency ablation has also been used to treat brain metastases.  As has hyperthermia.

Generally, aggressive treatment of treatable brain metastases is indicated where conditions are favorable, with failures coming from local recurrence of the treated brain metastases, emergence of new brain metastases, or progression of other systemic disease. [2]

Aggressive treatment of brain metastases is recommended if a person's functioning is good. [1,2] In a sense, this depends upon the location [whether near vital centers] and the size of the tumor, so it is worthwhile being alert to the possibility of brain metastasis, and being scanned if there is a suspicion, to diagnose them early.  MRI scans are more accurate for this purpose than CT scans.

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