Treatment of Adult Brain and Spinal Cord Tumors, by Type
The treatment options for brain and spinal cord tumors depend on several factors, including the type and location of the tumor, how far it has grown or spread, whether the tumor cells have certain gene or chromosome changes, and a person's age and overall health.

Non-infiltrating (grade I) astrocytomas
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 xanthroastrocytomas (PXAs), which are rare grade II tumors, are often treated the same way as these tumors as well.)

Many times, surgeons can’t be sure a tumor is one of these types until surgery is done to remove it. But if these tumors can be removed completely by surgery, they can often be cured (although this is less likely in older patients). 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 occurs in a place where it can’t be removed by surgery, such as in the hypothalamus or brain stem. In these cases, radiation therapy is usually the best option.

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.

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, although it’s not clear if it can help people live longer.

Low-grade (grade II) infiltrating astrocytomas
(Diffuse astrocytomas)
The initial treatment for diffuse astrocytomas is typically surgery to remove the tumor if it can be done. If surgery is not feasible, 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. If all of it can be removed, the patient may be cured.

Radiation therapy may be given after surgery, 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