what you will find on this page
Being told you may need treatment for a brain tumour can feel overwhelming. This page explains the standard treatments most often used - surgery, radiotherapy and chemotherapy - in plain language, so you can understand what each involves, why it might be recommended and what to expect. You’ll also find information about newer and targeted options, as well as links to trusted organisations for further support. Our aim is to give you clear, compassionate guidance to help you make informed choices and feel more confident about your care.
TREATMENTS
A biopsy is when doctors take a small sample of the tumour so it can be examined under a microscope. This shows exactly what type of tumour you have, which helps your medical team plan the most effective treatment.
A biopsy can also reveal whether you might be eligible for certain clinical trials, giving you access to treatments that aren’t widely available.
May affect speech, movement and memory
Biopsy
POST-OP DEFICITS
Some tumours are hard to reach
LOCATION CHALLENGES
General risks from surgery
anaesthetic risks
what TO CONSIDER
Ease pressure of neurological symptoms
SYMPTOM RELIEF
Reduce tumour size and remove entirely
REMOVAL
Confirm tumour type and grade
DIAGNOSIS
what surgery can do
Tumours in central areas of the brain, or those close to important blood vessels, can be more challenging and risky to operate on.
Surgery might be done to:
- Confirm the exact type of tumour through diagnosis
- Remove the tumour, either fully or partially
- Relieve symptoms such as hydrocephalus, which is a build-up of fluid in the brain that increases pressure inside the skull
Risks of Surgery
For benign (non-cancerous) tumours, surgery can sometimes remove the tumour completely, meaning no further treatment is needed. For more aggressive tumours, surgery can still be very helpful, it can provide a tissue sample to confirm the diagnosis, relieve symptoms and sometimes extend survival.
However, surgery doesn’t always remove every part of the tumour. In some cases, the safest option is to remove as much as possible and follow up with other treatments, like radiotherapy or chemotherapy.
- Relieve symptoms caused by the tumour
- Provide tissue for diagnosis
- Form an important part of treatment
Brain and spine surgery is a major procedure, and like any surgery, it carries risks. These risks depend on factors like your overall health, the type of tumour, and where it is in the brain.
In rare cases, symptoms can appear suddenly and surgery is needed straight away. More often, surgery is planned in advance. If your tumour is slow-growing, your surgery might be scheduled weeks or even months ahead. This allows your team to plan more complex techniques - for example, awake surgery, which lets the surgeon check key functions while removing the tumour.
Surgery
Brain surgery can sometimes cause long-term difficulties, depending on the tumour’s location and which parts of the brain or nerves are affected. These can include changes to speech, movement, memory, or other abilities. Doctors call these difficulties “deficits.”
Some deficits are temporary and improve with time, but recovery can take months or even years. Others may be permanent.
If you experience changes after surgery, you may benefit from support such as speech and language therapy, occupational therapy, physiotherapy, or psychological support.
These services can make a big difference, so it’s important to ask for help if you need it.
Before your operation, you’ll usually have an MRI or CT scan so your surgeon can plan exactly where and how to operate.
In some cases, your surgeon may recommend awake surgery.
This might sound daunting, but you’ll be given medication so you won’t feel pain. Being awake allows the surgical team to check your speech, movement, or other functions during the operation, helping them remove as much of the tumour as possible while protecting healthy brain tissue.
When a brain tumour is removed or biopsied, the tissue is usually placed straight into a preservative called formalin. This is essential for diagnosis and is the standard approach in the NHS. However, once tissue has been placed in formalin, it cannot later be used for certain types of testing or treatment.
Some current and emerging options - including whole genome sequencing, some personalised vaccines and some overseas or private treatments - require tumour tissue to be stored fresh frozen at the time of surgery. This is not routine practice in most hospitals and usually only happens if it has been planned in advance.
For patients having a biopsy or a very small amount of tumour removed, there may not be enough tissue to do anything beyond essential diagnostics. But for those having a larger tumour resection, there is sometimes an opportunity for a small amount of tissue to be stored fresh frozen in addition to what is needed for diagnosis.
The key point is timing. Decisions about how tumour tissue is handled are made during surgery, often before patients are aware there is a choice. Once tissue has been placed in formalin, that decision cannot be undone. Even if you are not currently considering clinical trials or private treatments, it may be worth asking your surgical team before surgery whether fresh-frozen tissue storage is possible in your case.
This information reflects current UK practice and guidance, including findings from the Tessa Jowell Brain Cancer Mission - Closing The Gap Report, which has highlighted limited access to fresh-frozen tumour tissue.
It’s usually best to wait at least 6 weeks before flying. This allows any air inside the head from surgery to be reabsorbed. Even after that time, you may still feel more tired than usual, so try to plan extra rest and avoid overexerting yourself during travel.
In most cases, only the area where the incision is made will be shaved. This is usually a small strip, around 10–15 cm long and about 2 cm wide. Your hair should begin to grow back after the operation.
Offers the best chance of control if tumour can be fully removed
Longer recovery, higher risk
May be done later, once treatment plan is confirmed
Remove all of the tumour (if safely possible)
FULL REMOVAL
Can ease symptoms and help other treatments work better
Moderate recovery time
Used when full removal isn’t safe or possible
Take out some of the tumour
PARTIAL REMOVAL
Gives the answers needed to plan next steps
Quicker recovery, lower risk
Often done first to guide treatment
Find out what kind of tumour it is
BIOPSY
BENEFIT
RECOVERY
TIMING
GOAL
Whenever possible, surgeons aim to remove as much of the tumour as they can in a single operation, so you only need one anaesthetic.
If doctors aren’t certain the growth is a tumour, they may recommend a biopsy first to confirm the diagnosis. In some urgent cases, a smaller initial operation may be done to stabilise your condition, with a larger, planned surgery scheduled later to remove more of the tumour.
Although brain surgery is a major procedure, most people are able to go home within 2–4 days. Full recovery takes much longer - often several months - and can vary depending on your overall health, the type of surgery, and whether you experience any complications.
You’ll usually have a follow-up scan within 48–72 hours after surgery, often before you leave hospital, to check how much of the tumour was removed and to assess your recovery.
Sometimes surgery isn’t possible because the tumour is in a location that makes it too risky - for example, if it’s close to or wrapped around vital brain structures. In these cases, the risks of surgery may outweigh the potential benefits.
If your consultant recommends against surgery, ask them to explain their reasoning. If you’re unsure or would like reassurance, you can request a second opinion [link to how to get a second opinion]. Your GP or consultant can help arrange this.
A team of specialists then designs a personalised radiotherapy plan. It’s checked, approved by doctors, and sometimes goes through extra quality-assurance steps before treatment can begin. All this means it usually takes around 2–3 weeks from your planning scan to your first session.
Before you start, there’s a detailed preparation process. You’ll usually have a lightweight mask made to keep your head in the exact same position for every session (slightly different if treating the spine). You’ll then have a CT planning scan, which can be combined with earlier MRI scans. These images help the team map the tumour, the surrounding area, and any healthy structures that need to be protected.
Radiotherapy begins, guided by your personalised plan
TREATMENT STARTS
6
Everything is double-checked for accuracy and safety
QUALITY CHECK
5
Your care team carefully maps the tumour and areas to protect
Tumour outlining
4
Your CT is aligned with your MRI so the tumour can be precisely located
Scan merge
3
A CT scan helps your team plan exactly where to treat
Planning scan
2
A custom mask is made to gently keep your head still during treatment
Mask fitting
1
Radiotherapy uses high-energy X-rays to damage the DNA inside cells. Tumour cells are usually less able to repair this damage than healthy cells, so giving small doses each day over several weeks means more harm is done to the tumour than to normal tissue.
Modern radiotherapy is very precise and carefully planned. Even so, treatment often includes not just the visible tumour but also a margin of surrounding tissue, because many brain tumours spread into nearby areas of the brain.
For most people having radiotherapy for brain or spine tumours, side effects are usually manageable. Common short-term effects include hair loss in the treated area, tiredness, and mild skin redness. If the spine is being treated, you might also experience a sore throat or nausea, depending on the area targeted.
Some side effects can appear months or even years after treatment. These can include problems with memory or concentration, a higher risk of stroke, hormonal changes, or cataracts. There’s also a small chance of developing a second cancer later in life - this risk is low (less than 2% at 20 years).
If you’re having radiotherapy and chemotherapy at the same time, you may also notice extra side effects from the chemotherapy. Your team will explain what to watch for and how to manage them.
If you would like more information about biopsy and surgery for brain tumours, then we would suggest reading the information on these links
General anaesthetics are sometimes used for children, usually between 6 months and around 7–10 years old, to help them stay still during treatment. For adults, having a general anaesthetic every day for radiotherapy isn’t practical or safe. It would mean longer, more complex sessions, higher risks and a tougher recovery after each treatment.
Instead, radiotherapy for adults is done while you’re awake. The team will work with you to make sure you’re comfortable and supported throughout, so you can get through each session without needing an anaesthetic.
Most radiotherapy sessions take around 20 minutes from start to finish. The first few appointments may be a bit longer while you and the team get used to the process and your exact positioning.
For most brain tumour treatments, the actual time the radiation beam is on is only about 4 minutes - the rest is spent carefully setting you up in the correct position. More complex treatments can take longer, and stereotactic radiotherapy sessions can last much longer, sometimes even hours.
Proton beam therapy delivers the same total dose to the tumour as standard radiotherapy but can sometimes reduce the amount of radiation reaching nearby healthy tissue. In theory, this could lower the risk of long-term side effects.
However, at the moment there isn’t strong enough evidence to prove that proton therapy works better than traditional photon radiotherapy for most brain tumours. It’s also very expensive to build and run, so it’s mainly offered where there’s a clear benefit.
Right now, it’s mostly used for a few rare tumours, such as clival chordomas and sometimes medulloblastomas. There’s also an ongoing study - the APPROACH trial - looking at whether proton therapy causes fewer side effects than photon therapy in people with oligodendroglioma.
Only at specialist centres
Available in some centres
Widely available in UK
Availability
Fewer, but not always better
Fewer, more localised effects
Affects more healthy tissue
Side effects
Very high (minimises spread)
High (focused on tumour)
Moderate (whole area)
Precision
20–30 (varies by condition)
1–5 targeted sessions
20–30 daily treatments
No. of sessions
Proton Beam
Stereotactic (SRT)
Standard Photon
Cost
NHS funded
NHS funded (criteria apply)
Expensive, limited NHS use
Stereotactic radiotherapy is a highly targeted form of radiotherapy that delivers very high doses of radiation to a precisely defined area, usually over 1–3 treatments. The aim is to destroy any cells within that exact target, much like surgery would, but without making an incision.
It can be very effective for certain conditions, such as brain metastases or some meningiomas. However, it’s not usually suitable for tumours that are more spread out, like most gliomas.
Specialised machines are often used to give this treatment - you might hear names like GammaKnife, CyberKnife, or Zap-X. These are all just different technologies for delivering the same type of highly precise radiotherapy.
You’ll have regular blood tests and check-ins to make sure treatment is safe and effective
Side effects
You may feel tired, sick, or more prone to infections but not everyone experiences this
Monitoring
Chemo can be taken as tablets or through a drip (IV), depending on the treatment plan
How it's given
Chemotherapy uses drugs to destroy fast-growing tumour cells or stop them multiplying
How it works
Chemotherapy has been part of cancer care for decades, but it’s been used less often for brain tumours. It wasn’t until the late 1990s that research showed it could help some brain tumour patients, and in 2005 a major trial proved the benefits of Temozolomide.
Chemotherapy works by damaging cells that divide quickly, which includes tumour cells but also some healthy cells. This is why side effects happen. Common ones include tiredness, nausea and a higher risk of infection.
While on chemotherapy, you’ll have regular blood tests to check your health. If you become unwell, you may need urgent hospital care so any problems can be treated quickly.
Targeted drugs are newer treatments designed to work on specific genetic changes in tumour cells. They only help if your tumour has the exact abnormality the drug is designed for, so your tumour sample needs to be tested first.
While there are fewer targeted drugs for brain tumours than for some other cancers, some options do exist, for example, drugs for tumours with IDH mutations or nTRK fusions.
(You can read more about these terms in the Pathology section.)
You may be offered a targeted drug
yes
You might be considered for a clinical trial or standard care
NO
Only certain mutations have treatments available on the NHS
Is a Suitable Drug Available?
Targeted drugs won’t work here. Standard treatment will be recommended
yes
NO
Some tumours have changes that can be targeted by specific drugs
Mutation Found?
Your team might not recommend it based on tumour type or available evidence.
yes
NO
Your tumour may be tested to look for specific genetic mutations
Genetic Testing
Ask early. They can refer you to a fertility specialist before treatment starts
Talk to your team
Not everyone becomes infertile – it depends on your treatment and age
Not always affected
Chemo can harm a developing baby – reliable contraception is essential during treatment
Contraception needed
Fertility preservation needs to happen before chemotherapy begins
Time-sensitive
Usually takes 2–3 weeks. Can delay treatment slightly, so timing is key
Egg Freezing
Quick and non-invasive. Best done before chemo starts
Sperm Banking
If you’d like the option to have children in the future, there are ways to preserve fertility:
- For men: sperm banking is usually quick and straightforward.
- For women: egg or embryo freezing is possible, though it’s a more involved process.
During chemotherapy and for at least 6 months afterwards, you should use barrier contraception, such as condoms. Chemotherapy is not a reliable form of birth control and pregnancies during treatment can be risky.
For most people with brain tumours, complete hair loss is very unlikely. Hair loss is more often caused by radiotherapy than chemotherapy and when it happens, it’s usually patchy rather than total.
Some people choose to shave their head so their hair is all the same length, but this is a personal choice, speak with your clinical team before making any decisions.
If you have longer hair, patchy hair loss can sometimes be hidden, so it may not be very noticeable. How much hair you lose will depend on the location of your tumour and the type of radiotherapy you’re having.
For most people with brain tumours, the answer is no. The most common chemotherapy drugs are taken as tablets at home. Sometimes, they’re given as a slow injection that takes about 20 minutes, rather than being attached to a drip for hours.
If your treatment does involve chemotherapy through a drip, it’s usually only needed once every 2–3 weeks. On those days, expect to spend a few hours at the hospital to allow time for preparation, the treatment itself and any checks before you leave.
To find out more information about Optimising treatment beyond standard care click here
For information on targeted agents:
For information on specific drugs:
If you would like more information about chemotherapy for brain tumours, we would suggest reading the following sources:
Ask them about:
Symptom control (e.g. steroids, anti-epileptics)
Specialist palliative care
Wellbeing and psychological support
Access to charities / second opinions
Talk through the risks, benefits and goals of care with your team.
This stage can feel overwhelming, but there are options
New results might offer different options - ask if updated profiling is possible
Genetic testing can be helpful again at this stage
More limited benefit from chemo
Focus may shift to:
Avastin
Clinical trials
Supportive / palliative care
Symptom management
Options may include:
Lomustine or Lomustine + Temozolomide
Optune (if not already used)
Bevacizumab (Avastin) to reduce swelling or symptoms
Re-surgery or re-irradiation (in some cases)
Consider clinical trials
NO
YES
Is the tumour MGMT methylated?
Start by reviewing imaging and symptoms with your care team
The tumour has returned – what now?
Glioblastoma almost always comes back at some point. The aim of initial treatment is to delay this for as long as possible, so you have more time feeling well and recovering from surgery or other treatments, you can find more information here. [LINK TO IS THERE MORE PAGE]
Patients family
Access to a website like this would have been a breath of fresh air during the chaos and confusion that followed my husband’s diagnosis. Having clear, specialist-led information in one place would have helped us better understand what was happening, what options existed and how to navigate decisions with more confidence. At a time when everything felt overwhelming, clarity and compassion in how information was presented would have made a real difference. I’m really glad that this website now exists for others facing a similar situation.
Patients family
Tackling a GBM diagnosis is extraordinarily overwhelming, the stats bulldoze you & researching treatment options online is sole destroying. Having one consolidated place to connect with other patients, understand additional treatment options & potential trials & follow others journeys is incredibly comforting and very much needed. Thank you. It’s a tough journey and we only get through it by all sharing our discoveries to make each others experiences that little bit easier.
Thank you for putting the time aside for this website. Being a caregiver to a 10momths in GBM patient I can honestly say that this website will benefit future patients enormously.
Patient
When everything changed, I didn’t want medical jargon or endless links. I just wanted clear, honest information I could actually understand.
Having it all in one place helped. Finding the information together was a huge relief. We could stop Googling and start getting a clearer picture of what was going on.
I could come back when I was ready. Some days I read a lot. Some days I couldn’t read anything at all. Knowing I could come back without pressure really helped.
Knowing more made things feel less chaotic. Understanding my options didn’t fix everything, but it helped things feel a little less out of control.
This was about more than treatment. This affected my whole life - not just my health. Seeing emotional and practical support included made me feel like that was understood. I didn’t feel like I was doing this alone. It felt like someone had already done the hard work of pulling this all together for me - and that meant a lot!
This website is an independent resource, developed by the Horizons in Neuro-Oncology (HINO) team in the UK. Initial development was supported by Dr Matt Williams and Lillie Pakzad-Shahabi, with grant funding from Novocure to support ongoing work.
HINO maintains editorial independence. While the team collaborates with a range of healthcare organisations and receives grant support from Novocure, all content is created and reviewed by the HINO team and reflects their combined clinical expertise, professional experience, and lived experience as patients and caregivers.
While content is based on UK clinical practice, much of the information may be relevant to international readers. It is provided for general guidance and should not replace medical advice from your own healthcare team.
Please use this information to support discussions with your local oncology team, or see our advice on obtaining a second opinion.
