For more information, call
Alpharetta Cancer Center
3400 Old Milton Parkway
Alpharetta, GA 30005
Phone: (770) 751-0521
Fax: (678) 566-1611
Atlanta Cancer Center
1000 Johnson Ferry Road
Atlanta, GA 30342
Phone: (404) 851-8850
Fax: (404) 851-6010
Cherokee Cancer Center
1200 Oakside Drive
Canton, GA 30114
Phone: (770) 479-1761
Fax: (770) 720-4480
Forsyth Cancer Center
1100 Northside Forsyth Dr.,
Cumming, GA 30041
Phone: (770) 292-7000
Fax: (770) 292-7002
Management of tumors in the brain requires a complex multidisciplinary team of experts to deliver the best patient care. Radiation oncologists work very closely with neurosurgeons, medical oncologists, neuro radiologists, pathologists and others to deliver treatment.
Malignant Brain Tumors
Malignant brain tumors are often divided between primary brain tumors (those that arise in the brain) and metastatic lesions (those that spread to the brain from other sites). Management of these two types of cancer typically require different treatment options, depending on numerous factors including the health and age of the patient, as well as the tumor type, location and size.
Primary malignant brain tumors
Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor. GBM is a high-grade tumor that is treated initially with surgical resection, when possible, followed by daily external beam radiation therapy (EBRT) with chemotherapy (Temozolomide). Daily EBRT is usually preformed over 6 weeks’ time (about 30 treatments) and is delivered using highly conformal (IMRT with VMAT) and accurate (IGRT with Cone-beam CT) radiation techniques. Each treatment usually requires less than 10 minutes. GBM tumors rarely spread to other parts of the body, but may recur at the initial tumor site.
Lower-grade tumors (i.e. astrocytomas, oligodendrogliomas, anaplastic astrocytomas) also are usually treated with a combination of surgery, EBRT and chemotherapy. These typically have an overall better prognosis than high-grade tumors.
Metastatic Brain Tumors (Secondary Brain Tumors)
Tumors that have metastasized to the brain are the most common type of brain tumor. Tumors that have spread from lung cancer, breast cancer and melanoma account for 70-80% of all brain metastases. The most common treatment for brain metastases is radiation. Surgery may be considered in patients with a solitary lesion in certain situations depending on size, location, symptoms, type of cancer and overall health of the patient. Radiation is utilized after surgery to eradicate any residual microscopic disease.
Radiation for brain metastases is usually either a 10-15 treatment course of whole brain radiation (WBRT) over 2-3 weeks or a single treatment to the metastatic lesion(s) utilizing stereotactic radiosurgery (SRS). SRS at Northside Hospital is delivered utilizing specially-equipped linear accelerators or the Perfexion Gamma Knife system (coming on line in fall of 2015). Chemotherapy usually has limited use in the management of most brain metastases secondary to the blood-brain barrier. In some situations, SRS can be used after whole brain radiation for residual disease or for new lesions that develop after WBRT.
Benign Brain Tumors
Although benign brain tumors are not cancerous, they still can cause damage to normal brain tissue and very often require treatment. The most common benign tumors include meningiomas, pituitary tumors, as well as acoustic neuromas (sometimes referred to as this vestibular schwannomas). These lesions can often be successfully treated with either surgery or radiation or less commonly a combination of the two modalities. Radiation options to treat benign lesions include fractionated EBRT, fractionated stereotactic radiotherapy, or stereotactic radiosurgery. Chemotherapy is rarely required for management of benign primary brain tumors.
Intensity Modulated Radiation Therapy (IMRT) involves shaping the radiation beam to conform to the target to provide maximal sparing of normal tissues. Northside also utilizes VMAT (Volumetric Modulated Arc Therapy) to deliver IMRT treatments in an arc fashion, which can provide even greater normal-tissue sparing and shorten daily treatment times to only a few minutes.]
Image Guided Radiation Therapy (IGRT), utilizing Cone-beam CT prior to daily treatments, corrects for any daily variation in target positioning or patient set-up.
Stereotactic Radiosurgery (SRS) involves a single fraction of high-dose radiation. At Northside, SRS to the brain is performed with specially-equipped linear accelerators or Gamma Knife® Perfexion™ Technology.
Fractionated Stereotactic Radiotherapy (FSRT) is SRS delivered over 2-5 treatments. It may be used in situations where the size or location of the tumor may preclude SRS from being the optimal treatment option.
Gamma Knife® Perfexion™ Technology enables radiation oncologists to target tumors in the brain with unsurpassed accuracy. It delivers precisely focused high-dose beams of radiation to selected areas deep within the brain, without a scalpel and with minimal effect on surrounding normal brain tissue. Because of this extreme precision, the entire radiation treatment can be delivered in a single session, even when there are multiple tumors that require treatment.