Tumor Treating Fields (TTF) Therapy
Fellowship-trained brain tumor neurosurgeons • 12 New Jersey hospital affiliationsTumor Treating Fields (TTFields) is an FDA-approved treatment for glioblastoma (GBM) that uses low-intensity, alternating electric fields delivered through transducer arrays worn on the shaved scalp to disrupt the mitotic spindle during cancer cell divisio causing dividing tumor cells to die without significantly affecting non-dividing healthy brain cells. When added to standard temozolomide chemotherapy after surgery and radiation, TTFields extends median overall survival in newly diagnosed GBM.
Key takeaways
- TTFields (marketed as Optune) uses wearable scalp electrodes to deliver continuous low-intensity electric fields that disrupt glioblastoma cell division.
- The EF-14 triala randomized controlled study showed that adding TTFields to temozolomide chemotherapy extended median overall survival from 16 months to 20.9 months in newly diagnosed GBM.
- Treatment is continuous patients wear the device for at least 18 hours per day to achieve maximum benefit.
- TTFields is approved for newly diagnosed GBM (after surgery and chemoradiation) and for recurrent GBM.
- Atlantic Brain and Spine neuro-oncology coordinates TTFields prescription and support as part of the comprehensive GBM treatment program.
| Device name | Optune (Novocure) |
| FDA approval | Newly diagnosed GBM (2015) and recurrent GBM (2011) |
| Mechanism | Low-intensity alternating electric fields disrupt mitotic spindle during tumor cell division |
| Delivery | Four transducer arrays worn on shaved scalp; connected to a portable generator |
| Treatment duration | Continuous wear minimum 18 hours per day recommended |
| Used alongside | Temozolomide chemotherapy during maintenance phase; after surgery and chemoradiation |
| Survival benefit | Median OS 20.9 months (TTFields + TMZ) vs 16 months (TMZ alone) in EF-14 trial |
Timing and stay vary by patient and complexity. Your surgeon will confirm what to expect in your case.
How TTFields work
Cancer cells divide rapidly and continuously. During cell division (mitosis), a structure called the mitotic spindle forms to pull chromosomes to opposite poles of the dividing cell. TTFields deliver low-intensity (1 to 3 V/cm), intermediate-frequency (200 kHz) alternating electric fields through the tumor region. These fields interfere with the mitotic spindle apparatus, causing the dividing cell to die rather than successfully completing division.
Healthy brain cells, which divide rarely or not at all, are largely unaffected by TTFields which explains the favorable side effect profile compared to conventional chemotherapy or radiation.
The four transducer arrays are placed on the shaved scalp in a pattern designed to concentrate the electric field at the tumor location based on individual MRI anatomy. The field direction alternates between array pairs to maximize coverage of the tumor in all planes.
TTFields in the GBM treatment sequence
Standard newly diagnosed GBM treatment follows the Stupp protocol:
- Surgery: Maximal safe resection with brain tumor surgery including 5-ALA fluorescence and awake craniotomy where appropriate
- Concurrent chemoradiation: Six weeks of daily radiation therapy with concurrent daily temozolomide chemotherapy
- Maintenance temozolomide: Monthly cycles of temozolomide chemotherapy for 6 to 12 months
- TTFields (added to step 3): Continuous TTFields wear begins after chemoradiation is complete and continues throughout the maintenance chemotherapy phase
TTFields can also be used at recurrence when GBM progresses after initial treatment as a monotherapy or in combination with second-line agents.
Complementary treatments such as Gliadel wafer (BCNU-impregnated carmustine wafers placed in the tumor cavity at surgery) and GammaTile (surgically targeted radiation therapy) may also be integrated into the GBM treatment plan depending on individual patient factors.
Benefits and risks
Potential benefits
- Extends median overall survival in newly diagnosed GBM when added to standard chemotherapy
- Non-systemic treatment no additional chemotherapy toxicity, no hair loss from TTFields itself
- Well tolerated most common side effect is mild skin irritation under the arrays
- Portable device allows continued daily activity while on treatment
Possible risks
- Skin irritation or breakdown under the transducer arrays -- managed with array repositioning and skin care
- Requires shaved scalp for array placement a visible and ongoing change in appearance
- Device weight and continuous wear (18+ hours/day) can affect quality of life and sleep
- Benefit is additive to but does not cure GBM most patients still experience eventual tumor recurrence
Your surgeon will review the benefits and risks specific to your diagnosis during your consultation.
What recovery looks like
TTFields is an outpatient treatment with no procedure-related recovery. Starting and maintaining treatment involves:
- Initiation TTFields is started after completion of chemoradiation typically at week 10 to 12 after initial surgery. A Novocure device support specialist trains the patient and caregiver on array placement, device use, and skin care.
- Ongoing Continuous wear is the goal minimum 18 hours per day. Arrays are changed every 3 to 4 days by the patient or caregiver at home. Monthly neuro-oncology follow-up monitors compliance, skin health, and treatment response.
- MRI monitoring MRI of the brain every 2 to 3 months assesses tumor response. Array placement maps are updated when the MRI shows significant anatomical changes.
- Duration TTFields is continued until tumor progression or unacceptable toxicity. Some patients maintain treatment for years if the tumor remains controlled.
Frequently asked questions
How effective is TTFields for glioblastoma?
The EF-14 phase III trial showed that adding TTFields to temozolomide extended median overall survival from 16 months to 20.9 months, and 5-year survival from 5% to 13% a meaningful improvement in a disease with very limited options. Benefit was seen across all patient subgroups. The treatment is most effective when worn for the recommended 18 or more hours per day.
Can I work and live normally while wearing TTFields?
Yes. The device is portable and battery-powered, allowing most normal daily activities. Patients carry the generator in a shoulder bag or backpack. Driving, working, socializing, and light exercise are all feasible. The main lifestyle impact is the required continuous wear and the shaved scalp.
Does TTFields interact with other devices like pacemakers or cochlear implants?
Patients with implanted devices such as pacemakers, defibrillators, or cochlear implants should discuss TTFields with both their neuro-oncologist and the implanted device specialist before starting treatment. Specific compatibility assessments are required for each device type.
Is TTFields covered by insurance?
TTFields (Optune) is covered by Medicare, Medicaid, and most commercial insurers for FDA-approved indications. Prior authorization is required. Novocure provides a dedicated patient services team to assist with insurance navigation and reimbursement support.
This page is for general education and does not replace medical advice. Treatment decisions should be made with a qualified neurosurgeon based on your individual diagnosis and imaging. To discuss your options, call Atlantic Brain and Spine Brain Tumor Care at 973.993.7322 or request a consultation.
Glioblastoma Treatment Specialists at Atlantic Brain and Spine
Your procedure is performed by fellowship-trained, board-certified neurosurgeons and spine surgeons.
