How Is Brain Cancer Treated?

Last updated and reviewed on June 16, 2026.

Treatment for brain cancer is highly individualized. The plan for any given patient depends on the type and grade of the tumor, its location in the brain, the molecular features found in the pathology report, the person's age, their overall health, and their own goals and values. Brain tumor treatment nearly always involves more than one type of therapy, and the best outcomes happen when care is provided by a multidisciplinary team that includes a neurosurgeon, a neuro-oncologist (a medical oncologist who specializes in brain tumors), a radiation oncologist, a neuropathologist, and supporting staff, including nurses, social workers, and rehabilitation specialists.

Surgery

Surgery is usually the first treatment for most brain tumors, serving several purposes at once. It removes as much of the tumor as safely possible (which is called surgical resection), provides tissue for diagnosis and molecular testing, and can quickly relieve dangerous pressure inside the skull by reducing the tumor mass.

The extent of tumor removal matters. Studies consistently show that patients who have more tumor removed, a greater extent of resection, tend to do better than those who have less removed, for most tumor types. However, the brain has no spare parts. The surgeon must balance removing as much tumor as possible against protecting the brain functions that the patient needs for their quality of life.

• Craniotomy is the most common surgical approach. The surgeon removes a piece of the skull to access the tumor, removes as much tumor as is safely possible, and then replaces the bone. Recovery typically takes a few weeks.
• Awake craniotomy is used when the tumor is near critical areas of the brain, particularly areas involved in speech, language, or movement. The patient is kept awake during the portion of the surgery when the brain is being mapped, and the tumor near critical areas is being removed. This allows the surgeon to monitor the patient's responses in real time and avoid damaging functions the patient depends on. The idea sounds alarming, but most patients who have been through it report that it was far less frightening than expected.
• Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to open surgery for certain tumors. A laser probe is inserted through a small hole in the skull using MRI guidance and heats the tumor to destroy it. It is sometimes used for tumors in hard-to-reach locations or for treating recurrent tumors after prior radiation.
• Shunt placement is not a cancer treatment per se, but it addresses a dangerous complication of brain tumors. If a tumor blocks the flow of cerebrospinal fluid and causes hydrocephalus (dangerous pressure buildup), a surgeon may place a thin tube called a shunt to drain the excess fluid and relieve pressure.

Radiation Therapy

Radiation therapy is one of the most important treatments for brain cancer. It uses high-energy beams to damage the DNA of cancer cells, preventing them from dividing. Radiation can reach areas of the brain where surgery cannot safely go and can kill cancer cells that remain after surgery.

• Standard external beam radiation therapy (EBRT) delivers radiation from outside the body using a machine called a linear accelerator. For glioblastoma, the standard approach is 30 treatments (called fractions) of radiation given over 6 weeks, usually alongside chemotherapy.
• Stereotactic radiosurgery (SRS) delivered by systems like Gamma Knife, CyberKnife, or a specialized linear accelerator is a highly precise technique that delivers a large dose of radiation to a small, well-defined target in one session (or a small number of sessions). Despite the name, it does not involve a scalpel. SRS is commonly used for brain metastases, meningiomas, acoustic neuromas, and small recurrent tumors. Its precision minimizes radiation to surrounding healthy brain tissue.
• Proton beam therapy uses protons rather than X-rays to deliver radiation. Protons can be directed to deposit most of their energy directly in the tumor, with less radiation spilling out the other side. This can be particularly valuable in children (to minimize long-term effects on the developing brain) and for tumors near especially sensitive structures.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. In brain cancer, chemotherapy is often given alongside or after radiation therapy, depending on the tumor type.

•   is the most important chemotherapy drug for glioblastoma and some other high-grade gliomas. It is taken as a pill, which makes it convenient compared to intravenous chemotherapy. For newly diagnosed glioblastoma, the standard approach since 2005 has been to give temozolomide during radiation therapy (concurrent) and then for 6 months afterward (adjuvant). This combination, called the Stupp protocol, significantly improved survival compared to radiation alone.
• PCV chemotherapy (a combination of procarbazine, lomustine, and vincristine) is used for certain lower-grade gliomas, particularly oligodendrogliomas, usually after radiation. Research has shown that PCV combined with radiation significantly prolongs survival in IDH-mutant gliomas with 1p/19q codeletion.
• Lomustine (CCNU) and bevacizumab (Avastin) are among the drugs used for recurrent glioblastoma, though neither has yet been shown to extend life as dramatically in the recurrent setting as temozolomide does in the first-line setting.
• High-dose methotrexate is the backbone of treatment for primary CNS lymphoma.

Targeted Therapy

Targeted therapies block specific molecular features of cancer cells that help them grow. As our understanding of brain tumor molecular biology has grown, several targeted treatments have emerged:

• BRAF inhibitors (like dabrafenib and trametinib) are used for brain tumors with BRAF V600E mutations, which are found in certain astrocytomas, gangliogliomas, and other rare brain tumor types. These drugs can produce dramatic responses in some patients.
• IDH inhibitors (like ivosidenib and vorasidenib) target the mutated IDH1 and IDH2 enzymes found in low-grade and some high-grade gliomas. Vorasidenib received FDA approval in 2024 for Grade 2 IDH-mutant astrocytoma and oligodendroglioma after surgery, marking a major advance for patients with these tumors.

Tumor Treating Fields (TTFields)

• Tumor treating fields are a relatively new, FDA-approved treatment for glioblastoma. It works by using low-intensity electric fields delivered through electrodes worn on the scalp to disrupt the ability of cancer cells to divide. Patients wear a device called Optune on their head for most of the day (at least 18 hours per day is recommended for maximum benefit). It is used alongside standard chemotherapy after the initial radiation and temozolomide phase. Studies have shown that adding TTFields to maintenance temozolomide improves both progression-free and overall survival in newly diagnosed glioblastoma. Side effects are mainly skin irritation under the electrodes.

Immunotherapy

Immunotherapy uses the body's own immune system to fight cancer. In brain cancer, research is still evolving, but some approaches are showing promise:

• Checkpoint inhibitors like nivolumab and pembrolizumab have been tested extensively in recurrent glioblastoma, with limited success so far in unselected patients. Research continues to identify which patient subgroups may respond.
• Cancer vaccines like EGFRvIII vaccines and personalized neoantigen vaccines are in clinical trials for glioblastoma, with ongoing investigation.
• CAR T-cell therapy, which involves engineering a patient's own immune cells to attack brain tumor cells, is showing early promise in clinical trials.

What Is Supportive Care During Treatment?

Supportive care, also called palliative care, is an important and often misunderstood part of brain cancer treatment. It is not about giving up on treatment. It is about managing symptoms, side effects, and the emotional, practical, and spiritual challenges that come with a brain cancer diagnosis, so that you can feel as well as possible throughout your care.

Common components of supportive care for brain cancer patients include:

• Corticosteroids (like dexamethasone) are used to reduce brain swelling (edema) caused by the tumor. They can dramatically and quickly relieve symptoms like headache, weakness, and cognitive changes, though they carry their own side effects with prolonged use.
•  Anti-seizure medications (anticonvulsants) are given to patients who have had seizures. They are not routinely given as prevention to all brain tumor patients, but they are essential for those who have had seizure activity.
• Rehabilitation therapies, such as physical therapy, occupational therapy, and speech-language therapy, help patients regain or maintain function that has been affected by the tumor or by treatment. Many patients make meaningful improvements in strength, coordination, speech, and daily living skills with focused rehabilitation.
• Cognitive rehabilitation helps patients manage thinking and memory difficulties that can result from both the tumor itself and from radiation therapy.
•  Social work and emotional support from oncology social workers, counselors, and psychiatrists help patients and families navigate the emotional weight of a brain cancer diagnosis and treatment.
• Nutritional support helps patients manage treatment side effects that affect appetite and maintain the strength needed for treatment.

What Is Follow-Up Care After Treatment Ends?

When active treatment ends, regular follow-up care begins. For brain cancer, monitoring after treatment is especially important because recurrence is common with malignant tumors, and because some treatment effects, particularly radiation-related changes, can look alarming on imaging even when they are not true tumor recurrence. Distinguishing true recurrence from pseudoprogression or radiation necrosis can be one of the most challenging parts of managing brain tumor patients after treatment.

Follow-up care typically includes:

• Regular MRI scans on a schedule that your neuro-oncologist will determine based on your tumor type and grade. For glioblastoma, MRI is typically done every 2 to 3 months after completing radiation and during maintenance chemotherapy. For lower-grade tumors, the interval may be every 3 to 6 months.
• Neurological exams at each follow-up visit to assess function and detect any new changes.
• Management of ongoing effects from treatment, including seizure management, cognitive changes, hormonal effects, and steroid taper as appropriate.
• Survivorship planning for patients who achieve long-term remission, including monitoring for late effects of radiation (such as cognitive changes or secondary tumors) and connecting with survivorship resources.

Sources:

1. Stupp R, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New England Journal of Medicine. 2005;352(10):987–996. https://pubmed.ncbi.nlm.nih.gov/15758009/

2. Stupp R, et al. Effect of tumor-treating fields plus maintenance temozolomide vs maintenance temozolomide alone on survival in patients with glioblastoma. JAMA. 2017;318(23):2306–2316. https://pubmed.ncbi.nlm.nih.gov/29260225/

3. van den Bent MJ, et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma. Journal of Clinical Oncology. 2013. https://pubmed.ncbi.nlm.nih.gov/16782911/

4. Mellinghoff IK, et al. Vorasidenib in IDH1- or IDH2-Mutant Low-Grade Glioma. New England Journal of Medicine. 2023;389:589–601. https://www.nejm.org/doi/full/10.1056/NEJMoa2304194

5. National Cancer Institute. Adult Central Nervous System Tumors Treatment (PDQ) – Patient Version. https://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq

6. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines: Central Nervous System Cancers. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11889715/