Treatment for Brain and Spinal Cord Cancers

The Fred Hutchinson Cancer Center Brain and Spine Metastases Clinic offers the most advanced treatment options to patients who have cancer that has metastasized to the brain or spinal cord. Our treatments are based on the latest available scientific evidence and clinical research. 

Our goals for managing brain and spinal cord metastases are to:

  • Remove or destroy the cancer through surgery, radiation and/or chemotherapy 
  • Relieve symptoms that are caused by a tumor pressing on the brain or spinal cord
  • Improve the patient’s overall functioning and quality of life

Treatment Process

The type of treatment we recommend for you will depend on several factors, including the type of cancer you have, its location, your overall health and your individual wants and goals.

Treatment options may involve one or more of the following:

Palliative Care

Supportive and Palliative Care is specialized medicine for people who have a life-limiting or life-threatening condition. It is an additional layer of support for those with a serious illness. 

The palliative care team plays a central role within cancer care at Fred Hutch and within the Neuro-Oncology Clinic at Fred Hutch. 

Proton Therapy

Although Fred Hutch's Brain and Spine Metastases Clinic treats mainly brain and spine metastases, we use proton therapy to treat many types of primary, secondary and metastasized brain and central nervous system tumors at our proton therapy facility.

Brain Tumors Most Appropriate for Proton Therapy

Tumors of the brain may be benign (non-cancerous) or malignant (cancerous). Benign brain tumors need to be treated because they can cause serious health problems by pressing on sensitive areas of the brain. Additionally, some benign tumors can become malignant over time. Malignant tumors are classified as brain cancer when they originate in the brain. Because the brain is so complex, treatment to this area might have long-term implications to the nervous system or other organs. If you or someone you love has been diagnosed with a brain tumor, we recommend learning about all your treatment options before making a decision.

Advantages of Proton Therapy for Brain Tumors Over Standard X-ray Radiation

Too much radiation to the brain has been known to cause neurological dysfunction. Compared with X-ray radiation therapy, proton therapy for brain tumors results in less exposure to normal brain tissue, eyes, optic nerves, and pituitary gland. This is because protons precisely target a tumor and do not continue beyond it the way X-rays do. Less healthy brain tissue is irradiated with proton therapy than with X-ray/IMRT, therefore patients experience fewer side effects.

conventional versus radiation levels

Compared to other forms of radiation therapy, proton therapy (right, above) delivers less radiation to normal brain tissue. The extra exposure to healthy tissue that X-rays/IMRT deliver can be as much as getting 75,000 to 450,000 dental X-rays. This additional radiation increases the risk of side effects. 

Proton Therapy for Brain Tumors


There are different types of radiation therapy that can be used to treat brain metastases. Depending on how much the disease has spread, this treatment may be able to either stop or slow the growth of brain metastases. Radiation therapy may be used alone or along with other treatments, like surgery or systemic therapies.

The Different Types of Radiation Therapy

  • Gamma knife radiosurgery, a noninvasive or minimally invasive outpatient treatment for some patients with conditions that would typically require brain surgery or whole-brain radiation
  • Whole-brain radiation therapy, which is most often used for multiple brain tumors
  • Focused radiation therapy, which targets the tumor and immediate surrounding areas
  • Intensity-modulated radiotherapy (IMRT), which allows radiation to be more exactly shaped to fit the tumor

Before radiation treatment begins, your radiation oncologist will use an imaging technique such as an MRI, CT scan, PET scan, angiography or a SPECT scan to find out where you need radiation.

Your neuro-oncologist will discuss treatment options with you, which may include radiation therapy.

Proton Therapy

Proton therapy is an advanced therapy and an important alternative to conventional radiation for many types of cancer (and some noncancerous tumors).

Brain tumors are frequently located close to critical structures. The advantage of using protons to treat this cancer is that doctors can target high doses of radiation at the cancer with the goal of minimizing radiation to healthy tissues. This may reduce side effects. Fred Hutchinson Cancer Center – Proton Therapy is the only facility in a seven-state region to offer this treatment.

Systemic Therapies

Systemic therapies, such as chemotherapy and immunotherapy, use medication to attack fast-growing cancer cells or to stop the cells from dividing.

  • Chemotherapy can play an important role in treating brain metastases. It is often given by infusion, through lumbar puncture (spinal tap) or through a special port called an Ommaya reservoir that delivers medication directly to the brain.
  • Immunotherapy uses parts of the body’s own immune system to fight cancer. It can be used on its own as a treatment or in coordination with other treatments like traditional chemotherapy, surgery and/or radiation.
  • Targeted therapy blocks the growth of cancer cells by using drugs that interfere with growth signals in cancer cells.

Your neuro-oncologist will discuss treatment options with you, which may include systemic therapy.


Surgery may be a treatment option for your brain metastases, depending on the number of masses, size and location. Your symptoms may also help to define if surgery is the best treatment for you. Surgery is often used for single, large brain metastases.

Our neurosurgeons are specially trained on procedures related to brain metastases and offer some treatments using endoscopy. Endoscopy is a minimally invasive technique that uses small incisions and an endoscope (a thin, flexible, lighted tube) to see and remove the cancer. There is often less injury to other surrounding tissue with endoscopy, and recovery can be faster compared to traditional surgery.

Regardless of how much cancer is removed by surgery, radiation therapy and/or chemotherapy may also be used as part of your treatment. Your neuro-oncologist will work closely with your surgeon and radiation team.

Meet the Brain and Spinal Cord Cancer Care Team