Our Approach & Expertise

Our Team of Experts The team approach is vital in the treatment of brain tumors more

Having the correct diagnosis is critical to choosing the most appropriate treatment for a brain tumor. There are more than 120 different types of brain tumors, each with a separate pathology and biology, and each requiring a different diagnostic and therapeutic approach. Memorial Sloan-Kettering's neuropathologists are expert in identifying the specific features and characteristics of different types of brain tumors to ensure the right diagnosis.

Effective Treatments That Spare Healthy Tissue

Physicians at Memorial Sloan-Kettering use the most advanced technologies to remove brain tumors while sparing healthy tissue. To help plan surgery, we use imaging techniques -- such as functional MRI and diffusion tractography -- that can map areas of the brain, including speech and motor centers. (See below for additional information about these techniques.)

Our Publications Visit PubMed for journal articles from our brain tumor experts go

Our radiation oncologists use intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) to treat brain tumors. IMRT, which is one of the most advanced and precise radiation treatment techniques, uses radiation beams of varying intensity created to match specific tumor angles and shapes so that the tumor is targeted as precisely and uniformly as possible. This helps to reduce the dosage of radiation to healthy tissues and possibly the side effects of treatment.

Another type of radiation therapy used to treat brain tumors is IGRT, a sophisticated technique of radiation delivery that uses radiology imaging (x-ray and/or CT scans) taken immediately before treatment to guide radiation with even greater precision.

Innovations in Chemotherapy

At Memorial Sloan-Kettering, our doctors were the first to use chemotherapy for central nervous system lymphomas and oligodendrogliomas, and we continue to be at the forefront of developing therapies for these diseases. ^{1 2} Our neuro-oncologists are working to develop a number of new chemotherapy drugs, including targeted therapies (drugs that attack cancer cells specifically without harming normal cells), for these and other forms of brain cancer, like glioblastoma.

	Our Intra-Operative Imaging Suite View a slide show of our intra-operative imaging suite equipped with a MRI scanner

Studies underscore the strong correlation between a surgeon's experience and a patient's outcome following surgery. At Memorial Sloan-Kettering, our neurosurgeons operate on more than 600 brain tumors each year. We also offer our patients the most sophisticated diagnostic and treatment technologies available. Our surgical expertise combined with these advanced technologies enables us to treat a wide range of tumors with the best treatments currently available.

• Intraoperative Imaging Suite

  Memorial Sloan-Kettering is one of a few hospitals in the country that has an intraoperative imaging suite equipped with a high-field strength magnetic resonance imaging (MRI) scanner in the operating room. Performing brain surgery in this setting allows the neurosurgeon to reevaluate the tumor with MRI during the operation, enhancing precision, improving the degree of tumor removal, and reducing the need for a second surgery.

Frameless Stereotaxy

Frameless stereotaxy, also known as surgical navigation, is used in almost every brain tumor operation at Memorial Sloan-Kettering. Using stereotaxy, the neurosurgeon is able to plan an operation precisely and three-dimensionally without having to secure a rigid frame around the patient's head, which is normally required. The advantages of surgical navigation include increased accuracy, the possibility of working through a smaller incision (since the navigation system allows the neurosurgeon to "see" the lesion relative to the surface of the head), and possibly a shorter operation.

• Functional MRI

  Functional MRI (fMRI) is an imaging technology that can identify the location of the functional areas of the brain -- such as those responsible for movement or for the generation and comprehension of speech. The exact location of these areas varies among individuals, particularly when a large tumor has developed in the brain.

  Functional MRI is usually conducted at the same time as the standard MRI examination. While the patient is still in the MRI, he or she is asked to perform certain tasks such as tapping fingers, counting, or describing images. The neuroradiologist can determine which areas of the brain are actually performing these tasks and can map their location on the MRI images. These mappings can help the neurosurgeon plan the operation. The test is painless and brief and can have a positive impact on the final outcome.

• Fusion Software

  In addition to being able to view MRI images using the frameless stereotactic system, neurosurgeons at Memorial Sloan-Kettering can also view functional MRI information during an operation.

  Using a software program, the information learned from functional MRI -- such as the location of important brain areas, which includes those that control motor or speech function -- is "fused" onto the routine brain MRI during surgery. This allows the neurosurgeon to optimize the removal of tumor tissue that is close to essential areas of the brain, such as those responsible for movement or speech. This sophisticated software also allows information obtained during functional MRI testing to be integrated into the anatomic MRI that is used for stereotactic surgical navigation.

Stereotactic Radiosurgery & Radiotherapy

Our experts use precise (stereotactic) positioning, computer guidance from MRI scans, and other modern technologies enable radiation oncologists to deliver these high-dose radiation treatments to tumors anywhere in the brain.

Memorial Sloan-Kettering's Radiation Oncology and Medical Physics departments work together using stereotatic radiosurgery and radiotherapy to treat many kinds of brain tumors, including astrocytoma, glioblastoma, acoustic neuroma, meningioma, chordoma, and brain metastases from other cancers. Our experts from medical physics have contributed to the design of stereotactic radiation systems.

At Memorial Sloan-Kettering, we use a highly sophisticated system known as BrainLAB to deliver stereotactic radiation. Rather than using Gamma Knife or conventional linear accelerator radiosurgery systems, BrainLAB uses mini-multileaf collimators, which shape the radiation beam in such a way as to protect healthy tissue while delivering the dosage to the cancerous tissue. Treatments with the BrainLAB system can be accomplished on an outpatient basis.

This treatment is now being combined with various chemotherapeutic drugs targeting newly discovered mechanisms in cancer cells in an attempt to sensitize tumors to the radiation beam.

In addition to providing our patients with the very best care available, our physicians and scientists are working to improve the ways in which we diagnose and treat brain tumors. Fostering collaboration between Memorial Sloan-Kettering's clinical and research arms, the Brain Tumor Center generates research and preclinical data on primary brain tumors and metastatic tumors to the brain. This, in turn, promotes the translation of basic science and preclinical data into clinical trials.

Work undertaken through the Brain Tumor Center builds on initiatives already underway at Memorial Hospital and Sloan-Kettering Institute, including research that offers promising new leads in understanding the basic biology of diseases such as glioblastoma.

For more information, visit the Brain Tumor Center section of our Web site.

Find a Clinical Trial Find out about new research studies for brain tumors go

We offer a number of clinical trials of new targeted therapies for patients with primary brain tumors. Memorial Sloan-Kettering clinicians and scientists are also investigating the genetic makeup of brain tumors to develop more precise means of diagnosis, to find rational targets for therapy, and to overcome the resistance of the most common primary brain tumors to radiation therapy and chemotherapy.

We are also working to better understand a protein tumor marker, YKL-40, found to be elevated in the blood of patients with glioblastoma. Being able to track a tumor marker in patients with brain tumors could help with diagnosis, and also during treatment -- monitoring the effectiveness of therapy and identifying a potential recurrence. ¹

In addition, our neuro-oncology molecular imaging program is researching the specific molecular abnormalities that characterize malignant brain tumors and the use of positron emission tomography (PET) to help monitor the effects of therapy.

Memorial Sloan-Kettering is a member of the North American Brain Tumor Consortium (one of the National Cancer Institute's sponsored brain tumor research groups), which means that we have a number of NCI-sponsored clinical trials for patients with brain cancer as well as a several of our own protocols. We are also the lead institution in many of these multicenter trials.

Our Patient Stories Meet some of our patients and read their stories more

We believe that treating the whole person, not just the disease, is the best way to provide care for patients and family members coping with a diagnosis of a brain tumor. Our medical staff understands that having a tumor that affects the brain or spinal cord can be overwhelming, and we are always available to help address the needs and concerns of our patients and their family members.

Memorial Sloan-Kettering offers a broad range of psychosocial support programs designed to help patients and family members cope with the spectrum of issues related to life during and after treatment. For more information about the support services we offer patients with brain tumors, their families and caregivers, visit the Follow-Up Care & Support Services section of our Web site.

¹Abrey LE, Childs BH, Paleologos N, Kaminer L, Rosenfeld S, Salzman D, Finlay JL, Gardner S, Peterson K, Hu W, Swinnen L, Bayer R, Forsyth P, Stewart D, Smith AM, Macdonald DR, Weaver S, Ramsay DA, Nimer SD, DeAngelis LM, Cairncross JG. High-dose chemotherapy with stem cell rescue as initial therapy for anaplastic oligodendroglioma: long-term follow-up. Apr;8(2), Neurologic Oncology, 2006: 183-8. [PubMed Abstract]

²Abrey LE, Childs BH, Paleologos N, Kaminer L, Rosenfeld S, Salzman D, Finlay JL, Gardner S, Peterson K, Hu W, Swinnen L, Bayer R, Forsyth P, Stewart D, Smith AM, Macdonald DR, Weaver S, Ramsey DA, Nimer SD, DeAngelis LM, Cairncross JG. High-dose chemotherapy with stem cell rescue as initial therapy for anaplastic oligodendroglioma. : J Neurooncol. 2003 Nov;65(2):127-34. [PubMed Abstract]

³Hormigo A, Gu B, Karimi S, Riedel E, Panageas KS, Edgar MA, Tanwar MK, Rao JS, Fleisher M, DeAngelis LM, Holland EC.YKL-40 and matrix metalloproteinase-9 as potential serum biomarkers for patients with high-grade gliomas. Clin Cancer Res. 2006 Oct 1;12(19):5698-704. [PubMed Abstract]