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These tumors include pilocytic astrocytomas, which most often develop in the cerebellum in young people, and subependymal giant cell astrocytomas (SEGAs), which are almost always seen in people with tuberous sclerosis. Many doctors consider these tumors benign because they tend to grow very slowly and rarely grow into (infiltrate) nearby tissues.

Pleomorphic xanthoastrocytomas (PXAs), which are rare grade 2 tumors, are often treated the same way as these tumors.

Many times, surgeons can’t be sure a tumor is one of these types until it’s removed.

If these tumors can be removed completely by surgery, they can often be cured, although this is less likely in older people.

Treatment options after or instead of surgery

Radiation therapy may be given after surgery, particularly if the tumor is not removed completely, although many doctors will wait until there are signs the tumor has grown back before considering it. Even then, repeating surgery may be the first option.

The outlook is not as good if the tumor is in a place where it can’t be removed by surgery, such as the hypothalamus or brain stem. In these cases, radiation therapy is usually the best option.

Another option for tumors that can’t be removed might be laser interstitial thermal therapy (LITT), a minimally invasive surgical approach that uses a laser to heat and destroy tumor cells.

If surgery and radiation therapy are no longer good treatment options, chemotherapy, most often with temozolomide or the PCV regimen (procarbazine, CCNU, and vincristine), might be used at some point.

A targeted drug might also be an option if the tumor cells have certain changes, such as a BRAF or NTRK gene mutation. For SEGAs that can’t be removed completely with surgery, treatment with the targeted drug everolimus (Afinitor) may shrink the tumor or slow its growth for some time.

These are grade 2 tumors. Often, surgeons can’t be sure a tumor is a grade 2 astrocytoma until surgery is done to remove it. If surgery can’t be done for some reason, a biopsy may be done to confirm the diagnosis.

These tumors are hard to cure by surgery because they often grow into (infiltrate) nearby normal brain tissue. Usually, the surgeon will try to remove as much of the tumor as safely possible (known as a maximal safe resection).

Treatment options after surgery

Other treatments might be used after surgery. Sometimes lab tests of the tumor are used to help determine which of these treatments should be given:

• Radiation therapy may be given, especially if a lot of tumor remains. Younger adults whose tumors were small and not causing many symptoms may not need radiation unless the tumor shows signs of growing again. (In some cases, surgery may be tried again before giving radiation.) In people who are older or whose tumors are at higher risk of coming back for other reasons, radiation is more likely to be given after surgery.
• Chemotherapy, most often with temozolomide or the PCV combination regimen (procarbazine, CCNU, and vincristine), may also be given.
• A targeted therapy drug such as vorasidenib might be an option if the tumor cells are found to have an IDH1 or IDH2 gene mutation.

Treatment options instead of surgery

These same treatments may be used as the main treatment if surgery is not a good option for some reason.

Another option for tumors that can’t be removed might be laser interstitial thermal therapy (LITT), a minimally invasive surgical approach that uses a laser to heat and destroy tumor cells.

These are grade 3 or 4 tumors. Surgery is often the first treatment if an imaging test shows what is likely a high-grade astrocytoma, although the specific type of tumor might not be known until after the operation. The surgeon will remove as much of the tumor as is safely possible (known as a maximal safe resection). But because of the way these tumors grow into nearby areas, they are very hard to remove completely.

Treatment options after surgery or instead of surgery

Radiation therapy is typically given after surgery, often along with, or followed by, chemotherapy if a person is healthy enough. For some people who are in poor health or whose tumor cells have certain gene changes found on lab tests, chemo may be used instead of radiation therapy. Another option might be a targeted drug known as an IDH inhibitor, such as vorasidenib.

For tumors that can’t be treated with surgery, radiation therapy along with chemo is usually the best option.

Temozolomide is the most commonly used chemo drug. Others that might be used include carmustine (BCNU) and lomustine (CCNU). Combinations of drugs, such as the PCV regimen (procarbazine, CCNU, and vincristine), might also be an option. All of these treatments may shrink or slow tumor growth for some time, but they are very unlikely to get rid of it completely.

If standard chemo drugs are no longer effective, the targeted drug bevacizumab (Avastin, other brand names) may be helpful for some people, either alone or with chemo. Another option is a targeted drug known as an IDH inhibitor, such as vorasidenib or ivosidenib.

In general, these tumors can be very hard to control for long periods of time. Because these tumors are so hard to cure with current treatments, clinical trials of promising new treatments may be a good option.

Surgery is often the first treatment if an imaging test shows what is likely a glioblastoma (GBM), although the specific type of tumor might not be known until after the operation. The surgeon will remove as much of the tumor as is safely possible (known as a maximal safe resection), although these tumors are almost never removed completely because of the way they grow into nearby areas.

Treatment options after or instead of surgery

Most people will get radiation therapy after surgery. It is often given with and then followed by chemotherapy if a person is healthy enough. For some people who are older or in poor health, or whose tumor cells have certain gene changes found on lab tests, just one of these treatments (chemo or radiation therapy) might be used.

For tumors that can’t be treated with surgery, radiation therapy along with chemo is usually the best option.

Temozolomide is the chemotherapy drug most often used first. It can be taken as a pill.

Carmustine (BCNU) and lomustine (CCNU) are other commonly used chemo drugs. Combinations of drugs, such as the PCV regimen (procarbazine, CCNU, and vincristine), may also be used.

If standard chemo drugs are no longer effective, the targeted drug bevacizumab (Avastin, other brand names) may be helpful for some people, either alone or with chemo.

Another option might be tumor treating fields therapy (TTF), also known as alternating electrical field therapy with the Optune Gio device. This can be used along with chemo (after surgery and radiation) as part of the initial treatment, or it can be used by itself (instead of chemo) for tumors that come back after treatment.

In general, glioblastomas can be very hard to control for long periods of time. Because they are so hard to cure with current treatments, clinical trials of promising new treatments may be a good option.

Most oligodendrogliomas are grade 2 tumors. A smaller number are grade 3 tumors (formerly known as anaplastic oligodendrogliomas), which tend to grow and spread more quickly.

As with most other brain tumors, surgery is typically the first treatment if it can be done, although it might not be clear what type of tumor it is at this point. The surgeon will remove as much of the tumor as is safely possible (known as a maximal safe resection). The tumor type is then determined by lab tests of the removed tumor.

Surgery alone usually doesn’t cure these tumors, but it can relieve symptoms and help people live longer.

Treatment options after surgery

Many oligodendrogliomas grow slowly, especially in younger people. If it appears that all or nearly all of the tumor has been removed, further treatment might not be needed right away. Instead, close monitoring (surveillance) might be done with MRIs every few months. Surgery may be repeated if the tumor grows back in the same spot.

Radiation therapy and/or chemo, most often with temozolomide or the PCV combination regimen (procarbazine CCNU, and vincristine), may also be options after surgery. Oligodendrogliomas tend to respond better to chemotherapy than some other brain tumors.

Another option after surgery might be a targeted therapy drug known as an IDH inhibitor, such as vorasidenib, especially if it looks as if all or nearly all of the tumor was removed.

Treatment options instead of surgery

If surgery cannot be done for some reason, a biopsy might be done instead to confirm the diagnosis. Other treatments, such as radiation therapy, chemotherapy, and/or targeted therapy, might still be helpful for these tumors.

These tumors usually do not grow into nearby normal brain tissue, and surgery to remove the tumor is typically the first treatment. Some people may be cured by surgery alone if the entire tumor can be removed, but often this is not possible. Spinal cord ependymomas have the greatest chance of being cured with surgery, but treatment can cause side effects related to nerve damage.

Treatment options after or instead of surgery

Radiation therapy is typically given to the area after surgery, especially if not all of the tumor was removed or if it is a grade 3 ependymoma. If the surgeon feels that all of the tumor was removed, close monitoring (surveillance) with MRIs every few months might be another option.

If surgery cannot be done for some reason, radiation therapy is typically the main treatment.

Sometimes the tumor cells can spread into the cerebrospinal fluid (CSF). People with ependymomas typically get an MRI of the brain and spinal cord (and often a lumbar puncture) a few weeks after surgery if it is done. If either of these tests shows that the cancer has spread through the CSF, radiation therapy is given to the entire brain and spinal cord (known as craniospinal radiation).

It’s not clear whether the benefits of chemotherapy outweigh the risks for these tumors, so it usually isn't given unless the tumor can no longer be treated with surgery or radiation.

Meningiomas begin in the meninges, the thin layers of tissue that cover the brain and spinal cord. They tend to look a certain way on an imaging test like an MRI, so doctors can often be fairly certain a tumor is a meningioma without needing to biopsy it.

Most meningiomas are grade 1 tumors that tend to grow slowly, so small tumors that aren’t causing symptoms can often be watched with regular MRIs rather than treated right away, particularly in older people.

If treatment is needed, these tumors can usually be cured if they can be removed completely with surgery. Radiation therapy may be given either after surgery or instead of surgery for tumors that can’t be removed completely.

For grade 2 (atypical/invasive) or grade 3 (anaplastic/malignant) meningiomas, which tend to come back after treatment, radiation therapy is typically given after surgery, even if all of the visible tumor has been removed.

For meningiomas that come back after initial treatment, further surgery (if possible) or radiation therapy may be used. If surgery and radiation aren’t options, drug treatments, such as targeted drugs or hormone-like drugs known as somatostatin analogs, may be tried, but it’s not clear how much benefit they offer. Because of this, taking part in a clinical trial of newer treatments might be a good option for some people.

These slow-growing tumors are usually benign. If they’re not causing symptoms, they might not need to be treated right away. Instead, they are watched closely with regular MRIs and hearing exams.

If treatment is needed, these tumors can usually be cured by surgery if it can be done, although this comes with a risk of side effects (such as hearing loss for acoustic neuromas).

In some centers, small acoustic neuromas are treated with precise radiation therapy techniques such as stereotactic radiosurgery (SRS) or proton beam therapy. 

For large schwannomas where complete removal is likely to cause problems, tumors may be operated on first to remove as much as is safe, and then the remainder is treated with radiation.

Different types of tumors can start in the spinal cord. If a spinal cord tumor is small and not causing symptoms, it might not need to be treated right away. When spinal cord tumors do need treatment, it’s often similar to what’s done for the same type of tumor in the brain.

Astrocytomas of the spinal cord usually cannot be removed completely. They may be treated with surgery to obtain a diagnosis and remove as much tumor as possible, and then by radiation therapy, or with radiation therapy alone. Chemotherapy might also be an option at some point, if needed.

Meningiomas of the spinal canal are often cured by surgery, as are some ependymomas. If surgery doesn’t remove the tumor completely, radiation therapy is often given.

Treatment of central nervous system (CNS) lymphomas generally consists of chemotherapy and/or radiation therapy. Treatment is discussed in more detail in Non-Hodgkin Lymphoma.

Some types of brain tumors that are seen more often in children can also occur occasionally in adults. Examples include:

• Brain stem gliomas
• Germ cell tumors
• Craniopharyngiomas
• Choroid plexus tumors
• Medulloblastomas and other embryonal tumors

Treatment of these tumors is described in Brain Tumors in Children.