Chemotherapy

Chemotherapy uses drugs to kill or stop the growth of cancer cells. It can be used alone or in addition to surgery or radiation therapy. Traditional " cytotoxic " chemotherapy is a systemic treatment, taken by pill or by a needle in the vein, muscle, or artery, that travels through the bloodstream killing cancer cells throughout the body. It works by causing cell damage that normal tissue can repair better than tumor tissue can. The drugs are often given in cycles to allow for recovery after each treatment.

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Chemotherapy has had mixed success in the management of brain tumors. However, it's clearly effective against certain pediatric tumors and some oligodendrogliomas, which are typically low-grade tumors that arise in the cells that produce myelin, a fatty substance that coats brain cell nerve fibers. It's been proved that chemotherapy improves survival rates in about 20 percent of patients with the most malignant of primary brain tumors, and tests predicting sensitivity to these drugs are beginning to emerge for certain tumors. In many cases, chemotherapy is now part of the standard of care in the treatment of some malignant adult brain tumors.

One possible explanation for chemotherapy's ineffectiveness in some cases is that the drugs used might be unable to pass from the bloodstream into the brain through the blood-brain barrier that keeps damaging substances–and potentially beneficial medications–from traveling through the bloodstream to the brain. Some investigators have tried to improve the effect of chemotherapy by disrupting this barrier, and results have been impressive in a certain type of tumor called primary central nervous system lymphoma.

Recently, new ways of delivering chemotherapy directly into tumor or brain tissue have allowed patients to receive chemotherapy or new types of medications without the systemic side effects. Chemotherapy wafers applied in the tumor at surgery slowly secrete chemotherapy into the tumor. Investigational infusion (slow, continuous injection) of chemotherapy called " convection enhanced delivery " is also being used in some cases.

Drugs that are aimed not at killing the cells but rather at changing growth or altering other cell functions are also being used. These growth modifiers, often called small molecule drugs or targeted therapies, have been shown to stop or shrink some primary tumors that resist other treatments. New drugs in this class are actively under development.