Treatment of brain tumours

Gustave Roussy treats patients with meningiomas, gliomas, ependymomas, medulloblastomas, cerebral lymphomas, “solitary” cerebral metastases, chordomas and other skull base tumours.
A cerebral tumour is one which arises within the cranium. There are numerous types of such tumours. Their consequences and seriousness vary greatly depending on:

• their position (cerebral hemispheres, cerebellum, brain stem, pituitary, meninges, etc.)
• how invasive they are: they may be malignant tumours (cancerous), classified in various grades according to their degree of invasiveness, or benign (non-cancerous), some of which can progress to become malignant
• their nature (the tumour cell type) and their cytogenetic characteristics (whether or not there is specific remodelling of genetic material)

The treatment strategy which is recommended to the patient is very tightly linked to these factors. It is decided on by consultation between specialists from various disciplines (surgery, radiotherapy, oncology, neurology and pathological anatomy) and always makes allowances for the unique nature of each patient.         

Surgery is the first treatment considered for brain tumours whenever possible. It may be combined with radiotherapy and/or chemotherapy.     
The time period before treatment at Gustave Roussy commences may depend on several factors but at the most should always be between three and five weeks after the surgical procedure.   

Certain treatment, in particular surgery, may be carried out in other hospital centres, with which Gustave Roussy works closely: the Sainte-Anne Hospital Centre (Neurosciences Department), the Kremlin Bicêtre University Hospital Centre (CHU), the Pitié Salpêtrière CHU etc.

It is a special feature of Gustave Roussy care that young adults are managed in close collaboration with the Gustave Roussy department of Paediatrics.

Various methods are used to treat brain tumours: surgery, radiotherapy and chemotherapy. These can be employed singly or combined. The choice of treatment is made by consultation between specialists from different disciplines (surgery, radiotherapy, oncology, neurology and pathological anatomy) and always makes allowances for the unique nature of each patient.       
At Gustave Roussy, a personalised care plan (PPS) is handed to each patient. This document reviews the details and the process of treatment.   

Surgery

The initial treatment of brain tumours is surgical. If surgery can be considered, it aims to remove the largest possible amount of the tumour and to make a histological and cytological diagnosis. This surgery is carried out in other hospital centres (Sainte-Anne CH, Kremlin-Bicêtre CHU, Pitié-Salpêtrière CHU), as part of a coordinated care pathway. Gustave Roussy and the Sainte-Anne Hospital Centre in particular have established a framework agreement which formalises their medical and scientific collaboration. This facilitates comprehensive treatment of their patients.  

Radiotherapy and/or chemotherapy may be employed to complement the surgery. The objective of these therapies is to eliminate the tumour cells which are still present and to limit the risk of recurrence.

Radiotherapy

Radiotherapy is now very precise: this means that it can target the zones which require irradiation while sparing healthy tissue. At Gustave Roussy, every patient receiving a course of radiotherapy is advised to have a weekly outpatient appointment with a doctor. This follow-up visit allows a dialogue with the patient, the assessment of toxicity and possible adjustment of the treatment. New functional imaging techniques can be used to predict responsiveness of the tumour to radiotherapy and to assess the response after radiotherapy and thus personalise the treatment more effectively.     

Chemotherapy

Chemotherapy involves the use of various drugs, employed singly or in combination. Some new agents, known as targeted therapy, are being evaluated in clinical trials at Gustave Roussy. By targeting specific characteristics of each tumour, they aim to improve the efficacy of treatment while reducing its toxicity.

Neurology Committee

Dr Frédéric Dhermain
Chairman
Radiotherapist

Dr Nathalie Auger
Cytogenetics

Dr François Bidault
Imaging

Dr Sarah Dumont
Oncologist
 
Dr David Guyon
Oncologist
 
Dr Caroline Poisson
Oncologist

Dr C. Lacroix
Pathological Anatomist (Kremlin Bicêtre CHU)

Dr M. Choukri and Professor Parker
Neurosurgery (Kremlin Bicêtre CHU)

Drs E. Dezamis and Dr Pallud Johan
Neurosurgery (St Anne Hospital Centre)

Dr Sellami Noura
Radiotherapist