A brain tumour is an
abnormal growth of cells within the brain. It arises from glial cells of the
brain, lymphatic tissues, nerves and meninges. Benign brain tumours grow slowly
but they can compress adjacent parts of the brain. Malignant tumours grow rapidly
and they invade adjacent structures of the brain. Brain tumours are graded according
to the nature of cell growth. Grade I and II tumours are grouped as low-grade,
whereas grade III and IV are grouped as high-grade tumours. Prognosis
is better in low-grade
or benign tumours.
The
following types of brain tumours are seen commonly:
In children: Juvenile
pilocytic astrocytoma, craniopharyngioma, medulloblastoma,
brainstem glioma and
germ cell tumours.
In adults: Astrocytoma,
oligodendroglioma, ependymoma, meningioma, vestibular
schwannoma and lymphoma.
Cancers from other parts of the body can also spread to brain.
What
are the common symptoms of brain tumours?
* Headaches, usually in
the morning
* Vomiting
* Convulsions or
seizures
* Weakness in limbs
* Loss of balance while
walking
* Altered speech or
vision
* Altered behaviour
* Loss of orientation
* Memory lapses
How
are brain tumours diagnosed?
* Imaging: CT scan or
MRI scan of brain is commonly performed.
* Biopsy: A piece of
tumour is removed for examination by open surgery or in stereotactic fashion
using rigid frame to fix skull and localizing tumour under guidance of CT scan
or MRI.
Surgery: Maximum safe
resection of the tumour or at least a biopsy is the standard goal of surgery.
Radiation therapy:
Radiation kills tumour cells with high energy X-rays, gamma rays or protons. It
is usually started after surgery and given over 5-6 weeks.
Chemotherapy:
Chemotherapy is the use of drugs to kill cancer cells. It is given orally or
through veins. It is given concomitantly with radiation therapy in high-grade
tumours. It is also given in recurrent brain tumours after failure of initial
treatment.
What
are the advances in radiation therapy of brain tumours?
* 3-Dimensional
Conformal Radiation Therapy (3D-CRT) and Intensity Modulated Radiation Therapy
(IMRT):
CT scan and MRI are used
to delineate the tumour and computers are used for radiation planning. Only the
tumour and the high-risk region surrounding the tumour is radiated, avoiding
radiation to
the normal structures in
the brain.
* Stereotactic
Radio-surgery (SRS) and Stereotactic Radiotherapy (SRT): Highly precise
immobilization and image guidance system is used for treatment of selected brain
tumours. High dose of radiation is delivered only to the tumour with very minimal
spillage of dose to the rest of the sensitive brain structures. Stereotactic radiotherapy
is preferred in children. Stereotactic radio-surgery delivering high-dose of
radiation in single or a very few sessions is performed in adults with tumours
such as metastatic residual glioma, meningioma and schwannoma. Novalis-Tx and
Cyberknife are advanced machines to deliver such high-precision therapy.
* High-definition Rapid
Arc: This is the latest software advancement in radiation planning technology.
Radiation is delivered in continuous fashion moving the machine head and its
small components simultaneously around the patient's head targeting the tumour
by infinite small radiation beams. Radiation treatment with such a technique is
highly precise and fast. This is preferred in children and elderly patients who
cannot lie on treatment couches for long periods.
* Proton beam therapy:
Proton therapy avoids spillage of radiation dose to the surrounding brain. It
is preferred in children as well as in patients with recurrent tumours who have
received radiation therapy earlier.
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