There are important first steps a patient must take in order to maximize the chances of survival and a successful therapy.

First Steps of Treatment: Dr. Timothy Cloughesy explains the first steps of Neuro-Oncology Care, and outlines UCLA's Multi-disciplinary approach to effectively treat brain tumor patients

First one needs to clarify and confirm the pathologic diagnosis. This pathologic diagnosis is made based on the tissue obtained from the initial surgery. Going forward, the treatment plan will be created based on this diagnosis. This formal diagnosis is made by the neuro-pathologists and is the most important piece of information of any treatment plan.

It is important to note that it is critical to save all tumor tissue collected at the initial surgery. Not only for pathologic diagnosis but also many clinical trials down the road will require frozen tissue from the initial surgery.

Next we want to make sure the pathology diagnosis matches what we see on the MRI scan and what is going on with the patient. Taking all of these data points into consideration helps us get a better picture of what is going on with the patient, and can help us better determine how to move forward.

Once we are sure about the diagnosis we can move forward with Treatment Options. Sometimes the treatment will include a more extensive surgery in order to maximize the total resection of the tumor. In higher grade tumors, treatment options can include Radiation Therapy alone, combination therapy of Radiation and Chemotherapy, or combination therapy of Radiation and Chemotherapy followed by additional Chemotherapy.

The decision of what therapy to administer is provided by the Neuro-Oncologists.

If traditional therapy fails in the newly diagnosed setting, additional therapy can be administered in the recurrent setting.

The treatment approaches in the recurrent setting mirror some of the options in the newly diagnosed setting. For example, we will need to identify if the patient needs additional surgery for de-bulking or further tumor resection. The neuro-oncologist will also need to identify if further radiation is needed. Most of the time in these recurrent settings additional systemic treatment will need to occur. These forms of treatment can be either standard chemotherapy agents or experimental therapies as part of an ongoing clinical trial.