Brain Tumor Chemotherapy, Radiation, Other Therapies and Monitoring

Gliomas usually need treatment with chemotherapy about a month after you have recovered from surgery to slow the growth of the tumor and to address portions of tumor that could not be removed with surgery due to the potential for too much neurological damage. You can receive drug therapy at the Day Hospital in the Clinical Cancer Center at Froedtert Hospital. The facility provides patients with the highest level of care in a comforting treatment setting.

Systemic therapy for meningiomas is reserved for people who have tumors that can no longer be removed with surgery due to risks to their functions and who have exhausted their radiation therapy options. Chemotherapy and other drug therapies for meningiomas are limited.

Currently, there is no role for targeted therapy or immunotherapy for primary brain tumors. While immunotherapy has not yet been FDA-approved for primary brain tumors, there is some clinical research in process to assess its role.

Neuroprotective drugs are used to prevent damage to the brain that can be a side effect with different types of treatment. They are not currently used for primary brain tumors, but they represent an interesting area of potential future interventions to prevent treatment-induced injury in brain tumor patients. 

Optune^® Gio TTFields for Glioblastoma Brain Tumor Treatment

Optune Gio Tumor-Treating Fields (TTFields) are low-intensity alternating electric fields generated by a small medical device. TTFields penetrate the skin on the scalp to target and disrupt glioblastoma cancer cells. The electric fields can slow or stop cancer cells from dividing and growing. In clinical trials, TTFields treatment was proven effective, extending survival by three to five months. The treatment has not been shown to influence healthy brain cells. 

Depending on individual factors, doctors may prescribe TTFields for people ages 22 and older who have been newly diagnosed with glioblastoma — after they have had surgery to remove as much of the tumor as possible, plus radiation therapy. TTFields treatment is given with chemotherapy called temozolomide.

Doctors may also prescribe TTFields as a standalone therapy if a tumor has returned and other treatments, like radiation and chemotherapy, are no longer effective.  

How to use TTFields for Glioblastoma

The medical device that generates the electric fields is lightweight, weighing less than three pounds. You carry it in a small case, a messenger bag worn over the shoulder, or backpack style. Adhesive patches called transducer arrays are attached to the scalp and connected to the TTFields device. Because the patches are only effective when applied directly to the scalp, hair must be shaved off. You can wear a cap, scarf, wig or other head covering over the transducer arrays if you like. Any of these head coverings must be well ventilated so the transducer arrays don’t overheat.

Treatment is most effective when you are wearing the device and have it turned on for at least 18 hours per day. Talk with your doctor about when to take treatment breaks. 

The TTFields system comes with battery packs, so you can move around as usual while you go about your daily routine. The arrays shouldn’t get wet but you can shower wearing a shower cap, or you can take the arrays off for your shower. When sleeping or relaxing, you can plug the unit into a wall outlet. 

Your doctor will recommend the length of time you need to use the system as part of your glioblastoma treatment. You will have MRI scans to check your progress at intervals determined by your doctor. 

TTFields Side effects

TTFields treatment alone does not enter the bloodstream. If you have side effects, contact your doctor right away. Most people do not have major side effects, although TTFields can create a warm feeling on the scalp. A common side effect is skin irritation. While rare, some people have headaches, fatigue, muscle twitching or skin ulcers, or they may fall.

When TTFields is combined with the drug temzolomide, some people experience low blood platelet count, nausea, constipation, vomiting, seizures or depression. 

Insurance coverage

Most major insurance companies cover the TTFields device. Before you start treatment, talk with your insurance provider about any restrictions.

The Optune Gio trademark was used with permission from Novocure GmbH.

Radiation Therapy

In addition to chemotherapy, gliomas are treated with radiation therapy to slow tumor growth and address tumor tissue that couldn’t be removed with surgery.

For a meningioma, your team may recommend radiation therapy if surgery is not an option or if your tumor recurs (comes back) after surgery. 

Monitoring Your Brain Tumor During and After Treatment

All members of your treatment team are involved with ongoing care but your neuro-oncologist is a person you might think of as the “quarterback” of the brain tumor treatment team. This specialist will be one of the first you and your family see to discuss the results of imaging and biopsies, your diagnosis, and to begin laying out a treatment plan. The neuro-oncologist is in constant communication with other members of your care team including a neurosurgeon, radiation oncologist, medical oncologist and other key specialists. As you progress through treatment, you will meet with your neuro-oncologist for the following check-ins.

• Monitor your blood work.
• Watch for and manages side effects of treatment.
• Review MRI scans (along with a neuroradiologist) to assess treatment effectiveness, recommend changes if needed and monitor long-term to detect changes that need attention early. MRI scans are done every few months when you are on active treatment.
• Manage neurological symptoms that arise from your brain tumor. Symptoms can be managed with physical, occupational and speech therapies or medications like anti-seizure drugs or steroids prescribed by your neuro-oncologist.
• Discuss psychosocial issues such as adjustment disorders, anxiety or depression. Your neuro-oncologist will treat these issues or may refer you to a counselor.
• Monitor you through hospice and end-of-life care if needed.