Central Nervous System Tumors Treatment | Montefiore Einstein Comprehensive Cancer Center

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Puntos clave

An adult central nervous system (CNS) tumor is a disease in which abnormal cells form in the tissues of the brain and/or spinal cord.
A tumor that starts in another part of the body and spreads to the brain is called a metastatic brain tumor.
The brain controls many important body functions.
The spinal cord connects the brain to nerves in most parts of the body.
There are different types of brain and spinal cord tumors.
- Astrocytic Tumors
- Oligodendroglial Tumors
- Mixed Gliomas
- Ependymal Tumors
- Medulloblastomas
- Pineal Parenchymal Tumors
- Meningeal Tumors
- Germ Cell Tumors
- Craniopharyngioma (Grade I)
Having certain genetic syndromes may increase the risk of a CNS tumor.
The cause of most adult brain and spinal cord tumors is not known.
The signs and symptoms of adult brain and spinal cord tumors are not the same in every person.
Tests that examine the brain and spinal cord are used to diagnose adult brain and spinal cord tumors.
A biopsy is also used to diagnose a brain tumor.
- Sometimes a biopsy or surgery cannot be done.
Hay algunos factores que afectan al pronóstico (es decir, la posibilidad de recuperación) y a las opciones de tratamiento.

An adult central nervous system (CNS) tumor is a disease in which abnormal cells form in the tissues of the brain and/or spinal cord.

There are many types of brain and spinal cord tumors. The tumors are formed by the abnormal growth of cells and may begin in different parts of the brain or spinal cord. Together, the brain and spinal cord make up the central nervous system (CNS).

The tumors may be either benign (not cancer) or malignant (cancer):

Benign brain and spinal cord tumors grow and press on nearby areas of the brain. They rarely spread into other tissues and may recur (come back).
Malignant brain and spinal cord tumors are likely to grow quickly and spread into other brain tissue.

When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors cause signs and symptoms and need treatment.

Brain and spinal cord tumors can occur in both adults and children. However, treatment for children may be different than treatment for adults.

For information about lymphoma that begins in the brain, see Primary CNS Lymphoma Treatment.

A tumor that starts in another part of the body and spreads to the brain is called a metastatic brain tumor.

Tumors that start in the brain are called primary brain tumors. Primary brain tumors may spread to other parts of the brain or to the spine. They rarely spread to other parts of the body.

Often, tumors found in the brain have started somewhere else in the body and spread to one or more parts of the brain. These are called metastatic brain tumors (or brain metastases). Metastatic brain tumors are more common than primary brain tumors. Up to half of metastatic brain tumors are from lung cancer.

Cancer may spread to the leptomeninges (the two innermost membranes covering the brain and spinal cord). This is called leptomeningeal carcinomatosis.

The brain controls many important body functions.

The brain has three major parts:

The cerebrum is the largest part of the brain. It is at the top of the head. The cerebrum controls thinking, learning, problem solving, emotions, speech, reading, writing, and voluntary movement.
The cerebellum is in the lower back of the brain (near the middle of the back of the head). It controls movement, balance, and posture.
The brain stem connects the brain to the spinal cord. It is in the lowest part of the brain (just above the back of the neck). The brain stem controls breathing, heart rate, and the nerves and muscles used to see, hear, walk, talk, and eat.

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Anatomy of the brain; two-panel drawing showing the cerebrum, ventricles (fluid-filled spaces), cerebellum, brain stem (pons and medulla), and spinal cord. Also shown are the meninges and skull (left panel) and the choroid plexus, hypothalamus, pineal gland, pituitary gland, and optic nerve (right panel).

Anatomy of the brain showing the cerebrum, ventricles (with cerebrospinal fluid shown in blue), cerebellum, brain stem (pons and medulla), and other parts of the brain.

The spinal cord connects the brain to nerves in most parts of the body.

The spinal cord is a column of nerve tissue that runs from the brain stem down the center of the back. It is covered by three thin layers of tissue called membranes. These membranes are surrounded by the vertebrae (back bones). Spinal cord nerves carry messages between the brain and the rest of the body, such as a message from the brain to cause muscles to move or a message from the skin to the brain to feel touch.

There are different types of brain and spinal cord tumors.

Brain and spinal cord tumors are named based on the type of cell they formed in and where the tumor first formed in the CNS. The grade of a tumor may be used to tell the difference between slow-growing and fast-growing types of the tumor. The World Health Organization (WHO) tumor grades are based on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread.

WHO Tumor Grading System

Grade I (low-grade) — The tumor cells look more like normal cells under a microscope and grow and spread more slowly than grade II, III, and IV tumor cells. They rarely spread into nearby tissues. Grade I brain tumors may be completely removed by surgery.
Grade II — The tumor cells grow and spread more slowly than grade III and IV tumor cells. They may spread into nearby tissue and may recur (come back). Some tumors may become a higher-grade tumor.
Grade III — The tumor cells look very different from normal cells under a microscope and grow more quickly than grade I and II tumor cells. They are likely to spread into nearby tissue.
Grade IV (high-grade) — The tumor cells do not look like normal cells under a microscope and grow and spread very quickly. There may be areas of dead cells in the tumor. Grade IV tumors usually cannot be completely removed by surgery.

The following types of primary tumors can form in the brain or spinal cord:

Astrocytic Tumors

An astrocytic tumor begins in star-shaped brain cells called astrocytes, which help keep nerve cells healthy. An astrocyte is a type of glial cell. Glial cells sometimes form tumors called gliomas. Astrocytic tumors include the following:

Brain stem glioma (usually high grade): A brain stem glioma forms in the brain stem, which is the part of the brain connected to the spinal cord. It is often a high-grade tumor, which spreads widely through the brain stem. Brain stem gliomas are rare in adults.
Pineal astrocytic tumor (any grade): A pineal astrocytic tumor forms in tissue around the pineal gland and may be any grade. The pineal gland is a tiny organ in the brain that makes melatonin, a hormone that helps control the sleeping and waking cycle.
Pilocytic astrocytoma (grade I): A pilocytic astrocytoma grows slowly in the brain or spinal cord. It may be in the form of a cyst and rarely spreads into nearby tissues.
Diffuse astrocytoma (grade II): A diffuse astrocytoma grows slowly, but often spreads into nearby tissues. The tumor cells look something like normal cells. It is also called a low-grade diffuse astrocytoma.
Anaplastic astrocytoma (grade III): An anaplastic astrocytoma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells. An anaplastic astrocytoma is also called a malignant astrocytoma or high-grade astrocytoma.
Glioblastoma (grade IV): A glioblastoma grows and spreads very quickly. The tumor cells look very different from normal cells. It is also called glioblastoma multiforme.

Oligodendroglial Tumors

An oligodendroglial tumor begins in brain cells called oligodendrocytes, which help keep nerve cells healthy. An oligodendrocyte is a type of glial cell. Oligodendrocytes sometimes form tumors called oligodendrogliomas. Grades of oligodendroglial tumors include the following:

Oligodendroglioma (grade II): An oligodendroglioma grows slowly, but often spreads into nearby tissues. The tumor cells look something like normal cells.
Anaplastic oligodendroglioma (grade III): An anaplastic oligodendroglioma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells.

Mixed Gliomas

A mixed glioma is a brain tumor that has two types of tumor cells in it — oligodendrocytes and astrocytes. This type of mixed tumor is called an oligoastrocytoma.

Oligoastrocytoma (grade II): An oligoastrocytoma is a slow-growing tumor. The tumor cells look something like normal cells.
Anaplastic oligoastrocytoma (grade III): An anaplastic oligoastrocytoma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells. This type of tumor has a worse prognosis than oligoastrocytoma (grade II).

Ependymal Tumors

An ependymal tumor usually begins in cells that line the fluid-filled spaces in the brain and around the spinal cord. An ependymal tumor may also be called an ependymoma. Grades of ependymomas include the following:

Ependymoma (grade I or II): A grade I or II ependymoma grows slowly and has cells that look something like normal cells. There are two types of grade I ependymoma — myxopapillary ependymoma and subependymoma. A grade II ependymoma grows in a ventricle (fluid-filled space in the brain) and its connecting paths or in the spinal cord.
Anaplastic ependymoma (grade III): An anaplastic ependymoma grows quickly and spreads into nearby tissues. The tumor cells look different from normal cells. This type of tumor usually has a worse prognosis than a grade I or II ependymoma.

Medulloblastomas

A medulloblastoma is a type of embryonal tumor. Medulloblastomas are most common in children or young adults.

For more information about medulloblastomas in children, see Childhood Medulloblastoma and Other Central Nervous System Embryonal Tumors Treatment.

Pineal Parenchymal Tumors

A pineal parenchymal tumor forms in parenchymal cells or pineocytes, which are the cells that make up most of the pineal gland. These tumors are different from pineal astrocytic tumors. Grades of pineal parenchymal tumors include the following:

Pineocytoma (grade II): A pineocytoma is a slow-growing pineal tumor.
Pineoblastoma (grade IV): A pineoblastoma is a rare tumor that is very likely to spread.

For more information about pineal parenchymal tumors in children, see Childhood Medulloblastoma and Other Central Nervous System Embryonal Tumors Treatment.

Meningeal Tumors

A meningeal tumor, also called a meningioma, forms in the meninges (thin layers of tissue that cover the brain and spinal cord). It can form from different types of brain or spinal cord cells. Meningiomas are most common in adults. Types of meningeal tumors include the following:

Meningioma (grade I): A grade I meningioma is the most common type of meningeal tumor. A grade I meningioma is a slow-growing tumor. It forms most often in the dura mater. A grade I meningioma may be completely removed by surgery.
Meningioma (grade II and III): This is a rare meningeal tumor. It grows quickly and is likely to spread within the brain and spinal cord. The prognosis is worse than a grade I meningioma because the tumor usually cannot be completely removed by surgery.

A hemangiopericytoma is not a meningeal tumor but is treated like a grade II or III meningioma. A hemangiopericytoma usually forms in the dura mater. The prognosis is worse than a grade I meningioma because the tumor usually cannot be completely removed by surgery.

Germ Cell Tumors

A germ cell tumor forms in germ cells, which are the cells that develop into sperm in men or ova (eggs) in women. There are different types of germ cell tumors. These include germinomas, teratomas, embryonal yolk sac carcinomas, and choriocarcinomas. Germ cell tumors can be either benign or malignant.

For more information about childhood germ cell tumors in the brain, see Childhood Central Nervous System Germ Cell Tumors Treatment.

Craniopharyngioma (Grade I)

A craniopharyngioma is a rare tumor that usually forms in the center of the brain just above the pituitary gland (a pea-sized organ at the bottom of the brain that controls other glands). Craniopharyngiomas can form from different types of brain or spinal cord cells.

For more information about craniopharyngioma in children, see Childhood Craniopharyngioma Treatment.

Having certain genetic syndromes may increase the risk of a CNS tumor.

Anything that increases a person's chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop a brain or spinal cord tumor, and they can develop in people who don't have any known risk factors. Talk with your doctor if you think you may be at risk. There are few known risk factors for brain tumors. The following conditions may increase the risk of certain types of brain tumors:

Being exposed to vinyl chloride may increase the risk of glioma.
Infection with the Epstein-Barr virus, having AIDS, or receiving an organ transplant may increase the risk of primary CNS lymphoma. For more information, see Primary CNS Lymphoma Treatment.
Having certain genético síndromes may increase the risk brain tumors:
- Neurofibromatosis type 1 (NF1) or 2 (NF2).
- von Hippel-Lindau disease.
- Esclerosis tuberosa.
- Síndrome de Li-Fraumeni.
- Turcot syndrome type 1 or 2.
- Nevoid basal cell carcinoma syndrome.

The cause of most adult brain and spinal cord tumors is not known.

The signs and symptoms of adult brain and spinal cord tumors are not the same in every person.

Signs and symptoms depend on the following:

Where the tumor forms in the brain or spinal cord.
What the affected part of the brain controls.
El tamaño del tumor.

These and other signs and symptoms may be caused by CNS tumors or by other conditions, including cancer that has spread to the brain. Check with your doctor if you have any of the following:

Brain Tumor Symptoms

Morning headache or headache that goes away after vomiting.
Convulsiones.
Vision, hearing, and speech problems.
Pérdida de apetito .
Frequent nausea and vomiting.
Changes in personality, mood, ability to focus, or behavior.
Loss of balance and trouble walking.
Debilidad.
Unusual sleepiness or change in activity level.

Spinal Cord Tumor Symptoms

Back pain or pain that spreads from the back towards the arms or legs.
A change in bowel habits or trouble urinating.
Weakness or numbness in the arms or legs.
Trouble walking.

Tests that examine the brain and spinal cord are used to diagnose adult brain and spinal cord tumors.

Además de preguntarle sobre su historial de salud personal y el de su familia y hacerle un reconocimiento físico, su médico podría realizar las siguientes pruebas y procedimientos:

Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person's mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
Visual field exam: An exam to check a person's field of vision (the total area in which objects can be seen). This test measures both central vision (how much a person can see when looking straight ahead) and peripheral vision (how much a person can see in all other directions while staring straight ahead). Any loss of vision may be a sign of a tumor that has damaged or pressed on the parts of the brain that affect eyesight.
Tumor marker test: A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers. This test may be done to diagnose a germ cell tumor.
Gene testing: A laboratory test in which cells or tissue are analyzed to look for changes in genes or chromosomes. These changes may be a sign that a person has or is at risk of having a specific disease or condition.
Tomografía computarizada (tomografía computarizada): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an rayos X máquina. A teñir tal vez inyectado into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
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Computed tomography (CT) scan of the brain. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the brain.
MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). MRI is often used to diagnose tumors in the spinal cord. Sometimes a procedure called magnetic resonance spectroscopy (MRS) is done during the MRI scan. An MRS is used to diagnose tumors, based on their chemical make-up.
SPECT scan (single photon emission computed tomography scan): A procedure to find malignant tumor cells in the brain. A small amount of a radioactive substance is injected into a vein or inhaled through the nose. As the substance travels through the blood, a camera rotates around the head and takes pictures of the brain. A computer uses the pictures to make a 3-dimensional (3-D) image of the brain. There will be increased blood flow and more activity in areas where cancer cells are growing. These areas will show up brighter in the picture.
Exploración PET (tomografía por emisión de positrones): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET escáner rotates around the body and makes a picture of where glucose is being used in the brain. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. PET is used to tell the difference between a primary tumor and a tumor that has spread to the brain from somewhere else in the body.
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PET (positron emission tomography) scan. The patient lies on a table that slides through the PET machine. The head rest and white strap help the patient lie still. A small amount of radioactive glucose (sugar) is injected into the patient's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.

A biopsy is also used to diagnose a brain tumor.

If imaging tests show there may be a brain tumor, a biopsy is usually done. One of the following types of biopsies may be used:

Stereotactic biopsy: When imaging tests show there may be a tumor deep in the brain in a hard to reach place, a stereotactic brain biopsy may be done. This kind of biopsy uses a computer and a 3-dimensional (3-D) scanning device to find the tumor and guide the needle used to remove the tissue. A small incision is made in the scalp, and a small hole is drilled through the skull. A biopsy needle is inserted through the hole to remove cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
Open biopsy: When imaging tests show that there may be a tumor that can be removed by surgery, an open biopsy may be done. A part of the skull is removed in an operation called a craniotomy. A sample of brain tissue is removed and viewed under a microscope by a pathologist. If cancer cells are found, some or all of the tumor may be removed during the same surgery. Tests are done before surgery to find the areas around the tumor that are important for normal brain function. There are also ways to test brain function during surgery. The doctor will use the results of these tests to remove as much of the tumor as possible with the least damage to normal tissue in the brain.
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Craniotomy: An opening is made in the skull and a piece of the skull is removed to show part of the brain.

The pathologist checks the biopsy sample to find out the type and grade of the brain tumor. The grade of the tumor is based on how the tumor cells look under a microscope, and how quickly the tumor is likely to grow and spread.

The following tests may be done on the tumor tissue that is removed:

Inmunohistoquímica: prueba de laboratorio que utiliza anticuerpos para detectar ciertos antígenos ( marcadores ) en una muestra de tejido de un paciente. Los anticuerpos suelen estar unidos a una enzima o un tinte fluorescente. Después de que los anticuerpos se unen a un antígeno específico en la muestra de tejido, la enzima o el tinte se activa y el antígeno se puede observar bajo un microscopio. Este tipo de prueba se usa para ayudar a diagnosticar el cáncer y ayudar a distinguir un tipo de cáncer de otro tipo de cáncer.
Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
Cytogenetic analysis: A laboratory test in which the chromosomes of cells in a sample of brain tissue are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in certain chromosomes may be a sign of cancer. Cytogenetic analysis is used to help diagnose cancer, plan treatment, or find out how well treatment is working.

Sometimes a biopsy or surgery cannot be done.

For some tumors, a biopsy or surgery cannot be done safely because of where the tumor formed in the brain or spinal cord. These tumors are diagnosed and treated based on the results of imaging tests and other procedures.

Sometimes the results of imaging tests and other procedures show that the tumor is very likely to be benign, and a biopsy is not done.

Hay algunos factores que afectan al pronóstico (es decir, la posibilidad de recuperación) y a las opciones de tratamiento.

The prognosis and treatment options for primary brain and spinal cord tumors depend on the following:

The type and grade of the tumor.
Where the tumor is in the brain or spinal cord.
Whether the tumor can be removed by surgery.
Whether cancer cells remain after surgery.
Whether there are certain changes in the chromosomes.
Si el cáncer se acaba de diagnosticar o recidivó (volvió).
La salud general del paciente.

The prognosis and treatment options for metastatic brain and spinal cord tumors depend on the following:

Whether there are more than two tumors in the brain or spinal cord.
Where the tumor is in the brain or spinal cord.
How well the tumor responds to treatment.
Whether the primary tumor continues to grow or spread.

Puntos clave

There is no standard staging system for adult brain and spinal cord tumors.
Imaging tests may be repeated after surgery to help plan more treatment.
Central nervous system (CNS) tumors often recur, sometimes many years after treatment.

There is no standard staging system for adult brain and spinal cord tumors.

The process used to find out if cancer has spread to other areas of the brain or to other parts of the body is called staging. Brain tumors that begin in the brain rarely spread to other parts of the body. There is no standard staging system for brain and spinal cord tumors.

Treatment of primary brain and spinal cord tumors is based on the following:

The type of cell in which the tumor began.
Where the tumor formed in the brain or spinal cord.
The amount of cancer left after surgery.
The grade of the tumor.

Treatment of tumors that have spread to the brain from other parts of the body is based on the number of tumors in the brain.

Imaging tests may be repeated after surgery to help plan more treatment.

Some of the tests and procedures used to diagnose a brain or spinal cord tumor may be repeated after treatment to find out how much tumor is left.

Central nervous system (CNS) tumors often recur, sometimes many years after treatment.

A recurrent CNS tumor is a tumor that has recurred (come back) after it has been treated. The tumor may recur at the same place as the first tumor or in other parts of the CNS.

Puntos clave

There are different types of treatment for patients with adult brain and spinal cord tumors.
Se utilizan los siguientes tipos de tratamiento:
- Vigilancia activa
- Cirugía
- Radioterapia
- Quimioterapia
- Terapia dirigida
Supportive care is given to lessen the problems caused by the disease or its treatment.
Se están probando nuevos tipos de tratamiento en ensayos clínicos.
- Radioterapia con haz de protones
- Inmunoterapia
Treatment for adult central nervous system tumors may cause side effects.
Los pacientes podrían considerar la posibilidad de participar en un ensayo clínico.
Los pacientes pueden participar en ensayos clínicos antes, durante o después de comenzar su tratamiento para el cáncer.
Es posible que se necesiten pruebas de seguimiento.

There are different types of treatment for patients with adult brain and spinal cord tumors.

Different types of treatment are available for patients with adult brain and spinal cord tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Se utilizan los siguientes tipos de tratamiento:

Vigilancia activa

Active surveillance is closely watching a patient’s condition but not giving any treatment unless there are changes in test results that show the condition is getting worse. Active surveillance may be used to avoid or delay the need for treatments such as radiation therapy or surgery, which can cause side effects or other problems. During active surveillance, certain exams and tests are done on a regular schedule. Active surveillance may be used for very slow-growing tumors that do not cause symptoms.

Cirugía

Surgery may be used to diagnose and treat adult brain and spinal cord tumors. Removing tumor tissue helps decrease pressure of the tumor on nearby parts of the brain. See the General Information section of this summary.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radioterapia

La radioterapia es un tratamiento contra el cáncer que utiliza rayos X de alta energía u otros tipos de radiación para matar las células cancerosas o evitar que crezcan. La radioterapia externa utiliza una máquina fuera del cuerpo para enviar radiación hacia el área del cuerpo con cáncer.

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External-beam radiation therapy of the brain; drawing shows a patient lying on a table under a machine that is used to aim high-energy radiation. An inset shows a mesh mask that helps keep the patient's head from moving during treatment. The mask has pieces of white tape with small ink marks on it. The ink marks are used to line up the radiation machine in the same position before each treatment.

External-beam radiation therapy of the brain. A machine is used to aim high-energy radiation. The machine can rotate around the patient, delivering radiation from many different angles. A mesh mask helps keep the patient’s head from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.

Certain ways of giving external radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of radiation therapy include the following:

Conformal radiation therapy: Conformal radiation therapy uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor.
Intensity-modulated radiation therapy (IMRT): IMRT is a type of 3-dimensional (3-D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles.
Stereotactic radiosurgery: Stereotactic radiosurgery uses a rigid head frame that is attached to the skull to keep the head still during the radiation treatment. A machine aims a single large dose of radiation directly at the tumor. This procedure does not involve surgery. It is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery.

Quimioterapia

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Although most cannot, some chemotherapy drugs can cross the blood-brain barrier and reach tumor cells in the brain. Chemotherapy that is placed directly into the cerebrospinal fluid is called intrathecal chemotherapy. When chemotherapy is inserted in an organ, such as the brain, or a body cavity, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

To treat brain tumors, a wafer that dissolves may be used to deliver a chemotherapy drug directly to the brain tumor site after the tumor has been removed by surgery. The way the chemotherapy is given depends on the type and grade of tumor and where it is in the brain.

See Drugs Approved for Brain Tumors for more information.

Terapia dirigida

La terapia dirigida es un tipo de tratamiento que utiliza medicamentos u otras sustancias para identificar y atacar células cancerosas específicas.

Terapia con anticuerpos monoclonales terapia: los anticuerpos monoclonales son proteínas del sistema inmunitario proteínas hecho en el laboratorio para tratar muchas enfermedades, incluido el cáncer. Como tratamiento contra el cáncer, estos anticuerpos se adhieren a un objetivo específico en las células cancerosas u otras células que podrían estar causando el crecimiento del cáncer. De esta forma, los anticuerpos pueden eliminar las células cancerosas, bloquear su crecimiento o evitar que se propaguen. Los anticuerpos monoclonales son administrados por infusión. Pueden utilizarse solos o para transportar medicamentos, toxinaso material radioactivo directamente a las células cancerosas.
Bevacizumab is a monoclonal antibody that binds to a protein called vascular endothelial growth factor (VEGF) and may prevent the growth of new blood vessels that tumors need to grow. Bevacizumab is used in the treatment of recurrent glioblastoma.

¿Cómo actúan los anticuerpos monoclonales para tratar el cáncer? En este video se explica cómo los anticuerpos monoclonales, como el trastuzumab, el pembrolizumab y el rituximab, actúan bloqueando las moléculas que las células cancerosas necesitan para crecer, marcándolas para que el sistema inmunitario las destruya o transportando sustancias nocivas hacia ellas.

Other types of targeted therapies are being studied for adult brain tumors, including tyrosine kinase inhibitors and new VEGF inhibitors.

See Drugs Approved for Brain Tumors for more information.

Supportive care is given to lessen the problems caused by the disease or its treatment.

This therapy controls problems or side effects caused by the disease or its treatment and improves quality of life. For brain tumors, supportive care includes drugs to control seizures and fluid buildup or swelling in the brain.

Se están probando nuevos tipos de tratamiento en ensayos clínicos.

This summary section refers to new treatments being studied in clinical trials, but it may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Radioterapia con haz de protones

Proton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons (tiny particles with a positive charge) to kill tumor cells. This type of treatment can lower the amount of radiation damage to healthy tissue near a tumor. It is used to treat cancers of the head, neck, and spine and organs such as the brain, eye, lung, and prostate. Proton beam radiation is different from x-ray radiation.

Inmunoterapia

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

Immunotherapy is being studied for the treatment of some types of brain tumors. Treatments may include the following:

Dendritic cell vaccine therapy.
Gene therapy.

Treatment for adult central nervous system tumors may cause side effects.

Para obtener información sobre los efectos secundarios causados por el tratamiento para el cáncer, visite nuestra página sobre efectos secundarios.

Los pacientes podrían considerar la posibilidad de participar en un ensayo clínico.

Para algunos pacientes, participar en un ensayo clínico puede ser la mejor opción de tratamiento. Los ensayos clínicos son parte del proceso de investigación del cáncer y se realizan para determinar si los nuevos tratamientos para el cáncer son seguros y eficaces o mejores que el tratamiento estándar.

Muchos de los tratamientos estándar actuales para el cáncer se basan en ensayos clínicos anteriores. Los pacientes que participan en un ensayo clínico pueden recibir el tratamiento estándar o ser de los primeros en recibir uno nuevo.

Los pacientes que participan en ensayos clínicos también ayudan a mejorar la forma en que se tratará el cáncer en el futuro. Incluso cuando los ensayos clínicos no conducen a nuevos tratamientos efectivos, suelen responder preguntas clave y contibuir de forma significativa al avance de la investigación.

Los pacientes pueden participar en ensayos clínicos antes, durante o después de comenzar su tratamiento para el cáncer.

En algunos ensayos clínicos solo pueden participar aquellos pacientes que aún no han recibido tratamiento. Otros ensayos prueban tratamientos para pacientes con cáncer que no han mostrado una mejoría. También hay ensayos que prueban nuevas formas de evitar una recidiva (regreso) del cáncer o de reducir los efectos secundarios del tratamiento del cáncer.

Se están realizando ensayos clínicos en muchas partes del país. Puede encontrar información sobre los ensayos clínicos patrocinados por el National Cancer Institute en la página web de búsqueda de ensayos clínicos del NCI. Puede encontrar ensayos clínicos patrocinados por otras organizaciones en el sitio web ClinicalTrials.gov.

Es posible que se necesiten pruebas de seguimiento.

A medida que avanza el tratamiento, se le realizarán pruebas o controles de seguimiento. Es posible que se repitan algunas pruebas para diagnosticar o estadificar el cáncer con el fin de evaluar qué tan bien que está funcionando el tratamiento. Las decisiones sobre si continuar, cambiar o suspender el tratamiento pueden basarse en los resultados de estas pruebas.

Algunas de las pruebas se seguirán realizando de forma periódica después de que haya terminado el tratamiento. Los resultados de estas pruebas pueden mostrar si su afección ha cambiado o si el cáncer ha recidivado (regresado).

The following tests and procedures may be used to check whether a brain tumor has come back after treatment:

SPECT scan (single photon emission computed tomography scan): A procedure to find malignant tumor cells in the brain. A small amount of a radioactive substance is injected into a vein or inhaled through the nose. As the substance travels through the blood, a camera rotates around the head and takes pictures of the brain. A computer uses the pictures to make a 3-dimensional (3-D) image of the brain. There will be increased blood flow and more activity in areas where cancer cells are growing. These areas will show up brighter in the picture.
Exploración PET (tomografía por emisión de positrones): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET escáner rotates around the body and makes a picture of where glucose is being used in the brain. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
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PET (positron emission tomography) scan. The patient lies on a table that slides through the PET machine. The head rest and white strap help the patient lie still. A small amount of radioactive glucose (sugar) is injected into the patient's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.

Para obtener información sobre los tratamientos que se enumeran a continuación, consulte la sección Descripción general de las opciones de tratamiento.

Astrocytic Tumors

Brain Stem Gliomas

Treatment of brain stem gliomas may include radiation therapy.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Pineal Astrocytic Tumors

Treatment of pineal astrocytic tumors may include surgery and radiation therapy. For high-grade tumors, chemotherapy may also be given.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Pilocytic Astrocytomas

Treatment of pilocytic astrocytomas may include surgery to remove the tumor. Radiation therapy may also be given if some of the tumor remains after surgery.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Diffuse Astrocytomas

Treatment of diffuse astrocytomas may include the following:

Cirugía con o sin radioterapia .
Surgery followed by radiation therapy and chemotherapy.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Anaplastic Astrocytomas

Treatment of anaplastic astrocytomas may include the following:

Surgery and radiation therapy. Chemotherapy may also be given.
Surgery and chemotherapy.
A clinical trial of chemotherapy placed into the brain during surgery.
A clinical trial of a new treatment added to standard treatment.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Glioblastomas

Treatment of glioblastomas may include the following:

Surgery followed by radiation therapy and chemotherapy given at the same time, followed by chemotherapy alone.
Surgery followed by radiation therapy.
Chemotherapy placed into the brain during surgery.
Radiation therapy and chemotherapy given at the same time.
A clinical trial of a new treatment added to standard treatment.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Oligodendroglial Tumors

Treatment of oligodendrogliomas may include surgery with or without radiation therapy. Chemotherapy may be given after radiation therapy.

Treatment of anaplastic oligodendroglioma may include the following:

Surgery followed by radiation therapy with or without chemotherapy.
A clinical trial of a new treatment added to standard treatment.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Mixed Gliomas

Treatment of mixed gliomas may include surgery and radiation therapy. Sometimes, chemotherapy is also given.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Ependymal Tumors

Treatment of grade I and grade II ependymomas may include surgery to remove the tumor. Radiation therapy may also be given if some of the tumor remains after surgery.

Treatment of grade III anaplastic ependymoma may include surgery and radiation therapy.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Medulloblastomas

Treatment of medulloblastomas may include the following:

Surgery and radiation therapy to the brain and spine.
A clinical trial of chemotherapy added to surgery and radiation therapy to the brain and spine.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Pineal Parenchymal Tumors

Treatment of pineal parenchymal tumors may include the following:

For pineocytomas, surgery and radiation therapy.
For pineoblastomas, surgery, radiation therapy, and chemotherapy.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Meningeal Tumors

Treatment of grade I meningiomas may include the following:

Active surveillance for tumors with no signs or symptoms.
Surgery to remove the tumor. Radiation therapy may also be given if some of the tumor remains after surgery.
Stereotactic radiosurgery for tumors smaller than 3 centimeters.
Radiation therapy for tumors that cannot be removed by surgery.

Treatment of grade II and III meningiomas and hemangiopericytomas may include the following:

Surgery and radiation therapy.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Germ Cell Tumors

There is no standard treatment for germ cell tumors (germinoma, embryonal carcinoma, choriocarcinoma, and teratoma). Treatment depends on what the tumor cells look like under a microscope, the tumor markers, where the tumor is in the brain, and whether it can be removed by surgery.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Craniopharyngiomas

Treatment of craniopharyngiomas may include the following:

Surgery to completely remove the tumor.
Surgery to remove as much of the tumor as possible, followed by radiation therapy.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Para obtener información sobre los tratamientos que se enumeran a continuación, consulte la sección Descripción general de las opciones de tratamiento.

Treatment of spinal cord tumors may include the following:

Surgery to remove the tumor.
Radioterapia.
A clinical trial of a new treatment.

Para obtener información sobre los tratamientos que se enumeran a continuación, consulte la sección Descripción general de las opciones de tratamiento.

There is no standard treatment for recurrent central nervous system (CNS) tumors. Treatment depends on the patient's condition, the expected side effects of the treatment, where the tumor is in the CNS, and whether the tumor can be removed by surgery. Treatment may include the following:

Chemotherapy placed into the brain during surgery.
Chemotherapy with drugs not used to treat the original tumor.
Targeted therapy for recurrent glioblastoma.
Radioterapia.
Surgery to remove the tumor.
A clinical trial of a new treatment.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

Para obtener información sobre los tratamientos que se enumeran a continuación, consulte la sección Descripción general de las opciones de tratamiento.

Treatment of one to four tumors that have spread to the brain from another part of the body may include the following:

Radiation therapy to the whole brain with or without surgery.
Radiation therapy to the whole brain with or without stereotactic radiosurgery.
Stereotactic radiosurgery.
Chemotherapy, if the primary tumor is one that responds to anticancer drugs. It may be combined with radiation therapy.

Treatment of tumors that have spread to the leptomeninges may include the following:

Chemotherapy (systemic and/or intrathecal). Radiation therapy may also be given.
Cuidados de apoyo.

Puede utilizar la búsqueda de ensayos clínicos y encontrar ensayos clínicos sobre cáncer patrocinados por el NCI que acepten participantes. La búsqueda le permite filtrar los ensayos según el tipo de cáncer, su edad y el lugar donde se realizan los ensayos. También encontrará información general sobre los ensayos clínicos.

For more information from the National Cancer Institute about adult central nervous system (CNS) tumors, see the following:

Para obtener información general sobre el cáncer y otros recursos del Instituto Nacional del Cáncer, consulte:

Acerca del PDQ

Physician Data Query (PDQ) es la base de datos integral sobre el cáncer del Instituto Nacional del Cáncer (NCI). La base de datos del PDQ contiene resúmenes de la última información publicada sobre prevención, detección, genética, tratamiento, atención médica de apoyo y medicina complementaria y alternativa relacionada con el cáncer. La mayoría de los resúmenes se redactan en dos versiones. Las versiones para profesionales de la salud contienen información detallada escrita en lenguaje técnico. Las versiones para pacientes están redactadas en un lenguaje fácil de entender, que no es técnico. Ambas versiones contienen información sobre el cáncer correcta y actualizada. La mayoría de las versiones también están disponibles en español.

El PDQ es un servicio del NCI. El NCI es parte de los Institutos Nacionales de Salud (NIH), que son el centro de investigación biomédica del Gobierno federal. Los resúmenes del PDQ se basan en una revisión independiente de la literatura médica. No son declaraciones de políticas del NCI ni de los NIH.

Propósito de este resumen

This PDQ cancer information summary has current information about the treatment of adult central nervous system tumors. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Revisores y actualizaciones

Los consejos editoriales escriben los resúmenes de información sobre el cáncer del PDQ y los mantienen actualizados. Estos consejos están conformados por equipos de especialistas en el tratamiento del cáncer y otras especialidades relacionadas con esta enfermedad. Los resúmenes se revisan periódicamente y se modifican cuando hay información nueva. La fecha de actualización al pie de cada resumen indica cuándo fue el cambio más reciente.

La información de este resumen para pacientes procede de la versión para profesionales de la salud, la cual el Consejo Editorial del PDQ sobre el tratamiento para adultos revisa y actualiza de forma periódica según sea necesario.

Información sobre ensayos clínicos

Un ensayo clínico es un estudio para responder a una pregunta científica; por ejemplo, si un tratamiento es mejor que otro. Los ensayos se basan en estudios anteriores y en lo que se ha aprendido en el laboratorio. Cada ensayo responde a ciertas preguntas científicas para descubrir mejores maneras de ayudar a los pacientes con cáncer. Durante los ensayos clínicos de tratamiento, se recopila información sobre los efectos de un tratamiento nuevo y su eficacia. Si un ensayo clínico demuestra que un tratamiento nuevo es mejor que uno que se utiliza actualmente, el tratamiento nuevo puede convertirse en “estándar”. Participar en un ensayo clínico puede ser una opción para los pacientes. Algunos ensayos clínicos están abiertos solo a pacientes que aún no han comenzado el tratamiento.

Los ensayos clínicos se pueden encontrar en línea en el sitio web del NCI. Para obtener más información, llame al Servicio de Información sobre el Cáncer (CIS, por sus siglas en inglés), el centro de contacto del NCI, al 1-800-4-CANCER (1-800-422-6237).

Permiso de uso de este resumen

PDQ (Physician Data Query) es una marca registrada. Se autoriza el libre uso del contenido de los documentos del PDQ como texto. Sin embargo, no se podrá identificar como un resumen de información sobre cáncer del PDQ del NCI, salvo que se reproduzca en su totalidad y se actualice con regularidad. Por otra parte, se permite que los autores incluyan una oración como: “En el resumen del PDQ del NCI sobre la prevención del cáncer de mama se describen, de manera concisa, los siguientes riesgos: [incluir fragmento del resumen]”.

La forma recomendada para citar este resumen del PDQ es:

PDQ® Adult Treatment Editorial Board. PDQ Adult Central Nervous System Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389458]

Las imágenes de este resumen se utilizan con el permiso del autor, artista y/o editorial para uso exclusivo en los resúmenes del PDQ. Si desea usar una imagen de un resumen del PDQ sin incluir el resumen completo, debe obtener autorización del propietario. El National Cancer Institute no puede otorgar dicho permiso. Para obtener más información sobre el uso de las imágenes de este resumen o de otras ilustraciones relacionadas con el cáncer, consulte Visuals Online, una colección de más de 3,000 imágenes científicas.

Descargo de responsabilidad

La información de estos resúmenes no debe utilizarse para tomar decisiones sobre reembolsos de seguros. Puede encontrar más información sobre la cobertura de seguros disponible en Cancer.gov/espanol en la página Manejo de la atención médica del cáncer.

Contáctenos

Puede encontrar más información sobre cómo contactarnos o recibir ayuda en el sitio web Cancer.gov en la página Contact Us for Help. También puede enviar sus preguntas a Cancer.gov en el apartado E-mail Us del sitio web.

Donaciones

Central Nervous System Tumors