Question:  What are the treatments for Adult Central Nervous System Tumors ?
Answer: Key Points
                    - There are different types of treatment for patients with adult brain and spinal cord tumors.     - Five types of standard treatment are used:         - Active surveillance     - Surgery      - Radiation therapy     - Chemotherapy     - Targeted therapy        - Supportive care is given to lessen the problems caused by the disease or its treatment.    - New types of treatment are being tested in clinical trials.          - Proton beam radiation therapy     - Biologic therapy        - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.
                
                
                    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.
                
                
                    Five types of standard treatment are used:
                    Active surveillance     Active surveillance is closely watching a patients 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.       Surgery     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.    Even if 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.       Radiation therapy    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:             -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.  Certain ways of giving 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 is a type of external radiation therapy that 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) external 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 is a type of external radiation therapy. A rigid head frame 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.                -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.           The way the radiation therapy is given depends on the type and grade of tumor and where it is in the brain or spinal cord. External radiation therapy is used to treat adult central nervous system tumors.       Chemotherapy    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). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. To treat brain tumors, a wafer that dissolves may be used to deliver an anticancer 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.    Anticancer drugs given by mouth or vein to treat brain and spinal cord tumors cannot cross the blood-brain barrier and enter the fluid that surrounds the brain and spinal cord. Instead, an anticancer drug is injected into the fluid-filled space to kill cancer cells there. This is called intrathecal chemotherapy.    See Drugs Approved for Brain Tumors for more information.       Targeted therapy      Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.    Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.    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.   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.
                
                
                    New types of treatment are being tested in clinical trials.
                    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.     Proton beam radiation therapy     Proton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged pieces of matter) to make radiation. This type of radiation kills tumor cells with little damage to nearby tissues. 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.        Biologic therapy     Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.    Biologic therapy is being studied for the treatment of some types of brain tumors. Treatments may include the following:            -  Dendritic cell vaccine therapy.     -  Gene therapy.
                
                
                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
                
                
                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
                
                
                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.   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 that uses a special camera linked to a computer to make a 3-dimensional (3-D) picture of the brain. A very small amount of a radioactive substance is injected into a vein or inhaled through the nose. As the substance travels through the blood, the camera rotates around the head and takes pictures of the brain. Blood flow and metabolism are higher than normal in areas where cancer cells are growing. These areas will show up brighter in the picture. This procedure may be done just before or after a CT scan.     -   PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner 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.
                                 
                 
							            Treatment Options by Type of Primary Adult Brain Tumor
							            
							                
							                    Astrocytic Tumors
							                    Brain Stem Gliomas    Treatment of brain stem gliomas may include the following:            -  Radiation therapy.           Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult brain stem glioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.       Pineal Astrocytic Tumors    Treatment of pineal astrocytic tumors may include the following:            -  Surgery and radiation therapy. For high-grade tumors, chemotherapy may also be given.           Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult pineal gland astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.       Pilocytic Astrocytomas    Treatment of pilocytic astrocytomas may include the following:            -  Surgery to remove the tumor. Radiation therapy may also be given if tumor remains after surgery.           Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult pilocytic astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.       Diffuse Astrocytomas    Treatment of diffuse astrocytomas may include the following:            -  Surgery with or without radiation therapy.     - Surgery followed by radiation therapy and chemotherapy.           Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult diffuse astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.       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.           Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult anaplastic astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.       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.           Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult glioblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    Oligodendroglial Tumors
							                    Treatment of oligodendrogliomas may include the following:         -  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.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult oligodendroglial tumors. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    Mixed Gliomas
							                    Treatment of mixed gliomas may include the following:         -  Surgery and radiation therapy. Sometimes chemotherapy is also given.         Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult mixed glioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    Ependymal Tumors
							                    Treatment of grade I and grade II ependymomas may include the following:         -  Surgery to remove the tumor. Radiation therapy may also be given if tumor remains after surgery.        Treatment of grade III anaplastic ependymoma may include the following:         - Surgery and radiation therapy.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult ependymal tumors. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    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        Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult medulloblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    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.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult pineal parenchymal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    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 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 hemangiopericytoma s may include the following:         - Surgery and radiation therapy.         Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult meningeal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    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.   Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult central nervous system germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.
							                
							                
							                    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.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult craniopharyngioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.