Low-grade gliomas

We know how difficult a diagnosis of a brain tumor can be, both for your child and for your whole family. That’s why our physicians are focused on family-centered care: From your first visit, you’ll work with a team of professionals who are committed to supporting all of your family’s physical and psychosocial needs. We’ll work with you to create a care plan that’s best for your child. 

If your child has been diagnosed with a low-grade glioma, you’ll naturally be eager to know how your child’s physician will treat the tumor. Your child’s physician will determine a specific course of treatment based on several factors, including:

• your child's age, overall health and medical history
• type, location, and size of the tumor
• extent of the disease
• your child's tolerance for specific medications, procedures or therapies
• how your child's doctors expects the disease to progress

There are a number of treatments we may recommend. Some of them help to treat the tumor while others are intended to address complications of the disease or side effects of the treatment.

What treatments are available for low-grade gliomas?

If your child has been diagnosed with a low-grade glioma, he may receive one or more of the following treatments:

• surgery - usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible without compromising neurological function.
   
• radiation therapy - using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors. Due to the long-term damage that radiation can cause to the developing brain of a child, this treatment is usually only used as a last resort.
   
• chemotherapy- a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Modern treatments now include biologic (also called smart drugs) that target specific abnormal pathways required by the tumor to grow and spread. A number of these types of drugs are now in clinical trials in children with low-grade gliomas.

What is expected post-treatment for low-grade glioma?

The prognosis for a child with a low-grade glioma depends on tumor grade, location and in some cases, age of the child at diagnosis.

• Many low-grade gliomas are first treated with surgery and then monitored for regrowth. Grade I astrocytomas, for example, are usually cured with complete surgical removal alone.
   
• If, due to the tumor’s location, complete surgical resection is not an option, or if a tumor begins to grow back after it has been removed, the doctor may recommend chemotherapy.
   
• We usually don’t use radiation therapy unless your child’s tumor has grown after chemotherapy. Due to the potential side effects of radiation, including effects on learning and hormone function, it is best avoided if your child is young (especially under age 10).

What is chemotherapy?

Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.

How is chemotherapy given?

Your child may receive chemotherapy:

• orally, as a pill to swallow
   
• intramuscularly, as an injection into the muscle or fat tissue
   
• intravenously, directly to the bloodstream (IV)
   
• intrathecally, directly into the spinal fluid with a needle

Does chemotherapy cause side effects?

While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells. Because of this, your child may experience adverse side effects during treatment. Being able to anticipate these side effects can help you, your child and your care team prepare for, and, in some cases, prevent these symptoms from occurring, if possible.

How are side effects managed?

Side effects in the treatment of low-grade gliomas can arise from surgery, radiation and chemotherapy.

• Procedures should be performed in specialized centers where experienced neurosurgeons, working in the most technologically advanced settings, can provide the most extensive resections while preserving normal brain tissue.
   
• Radiation therapy often produces inflammation, which can temporarily exacerbate symptoms and dysfunction. To control this, inflammation steroids are sometimes necessary.
   
• Some of the chemotherapy agents are associated with fatigue, diarrhea, constipation and headache. These side effects can be effectively managed under most circumstances with standard medical approaches.

Our Pediatric Brain Tumor Program also has access to specialists who deliver complementary or alternative medicines. These treatments, which may help control pain and side effects of therapy include the following.

• acupuncture/acupressure
• therapeutic touch
• massage
• herbs
• dietary recommendations

Talk to your child’s physician about whether complementary or alternative medicine might be a viable option.

What about progressive or recurrent disease?

There are numerous standard and experimental treatment options for children with progressive or recurrent low-grade gliomas.

Dana-Farber Cancer Institute is one of nine institutes in the nation belonging to the Pediatric Oncology Experimental Therapeutic Investigators Consortium. The consortium is dedicated to the development of new and innovative treatments for children with newly diagnosed as well as progressive or recurrent brain tumors. We are also home to the world’s largest pediatric low-grade astrocytoma research program and the Department of Defense Neurofibromatosis Clinical Trial Consortium.

Resources and support

We understand that you may have a lot of questions if your child is diagnosed with a low-grade glioma. Will it affect my child long-term? What do we do next? We’ve tried to provide some answers to those questions in these pages, but there are also a number of resources and support services to help you and your family through this difficult time.

Long-term follow-up

Today, the majority of children and adolescents diagnosed with pediatric brain tumors will survive into adulthood. However, many of them will face physical, psychological, social and intellectual challenges related to their treatment and will require ongoing assessment and specialized care.

To address the needs of this growing community of brain tumor survivors, Dana-Farber/Children's Hospital Cancer Care established the Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic.

Today, more than 1,000 pediatric brain tumor survivors of all ages are followed by the Outcomes Clinic, a multi-disciplinary program designed to address long-term health and social issues for families and survivors of childhood brain tumors. Some of the post-treatment services provided by the Outcomes Clinic include:

• MRI scans to monitor for tumor recurrences
• intellectual function evaluation
• endocrine evaluation and treatment
• neurologic assessment
• psychosocial care
• hearing, vision monitoring
• ovarian dysfunction evaluation and treatment
• motor function evaluation and physical therapy
• complementary medicine

As a result of treatment, children may experience changes in intellectual and motor function. Among several programs addressing these needs are the School Liaison and Back to School Programs, which provide individualized services to ease children's return to school and maximize their ability to learn.

In addition to providing thorough and compassionate care, our Outcomes Clinic specialists conduct innovative survivorship research and provide continuing education for staff, patients and families.

To learn more about our services or to schedule an appointment, please click here or call us at 617-632-2680.