Cerebellar low-grade astrocytomas

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.

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. These treatments include:

Surgery

Doctors treat many low-grade astrocytomas with surgery and then carefully monitor them to watch for regrowth of the tumor. Grade I astrocytomas, for example, can be treated with complete surgical removal alone.

If the tumor is removed, children’s symptoms related to increased pressure within the brain, such as headache, vomiting and lethargy are usually relieved. A child’s coordination and balance usually improves, too. 

If the tumor recurs after initial surgical removal, or if the tumor re-grows after partial surgical removal, your child’s doctor may recommend a second attempt at surgical removal/de-bulking of the tumor.

Chemotherapy

Chemotherapy is a drug treatment that works by interfering with the tumor cell's ability to grow or reproduce. Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.

A number of combinations of chemotherapy drugs are used to treat cerebellar low-grade gliomas, including:

• vincristine with carboplatin
• vincristine with CCNU, procarbazine and thioguanine

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 (intravenously, or “IV”)
• intrathecally, directly into the spinal fluid with a needle (intrathecally)

Does chemotherapy cause side effects?

While chemotherapy can be quite effective in treating certain cancers, the drugs 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.

What are common side effects and how are side effects managed?

Common side effects to chemotherapy given for treatment of low-grade astrocytomas include fatigue, headache, diarrhea and constipation. These side effects can usually be effectively managed 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 radiation?

Our doctors may use precisely targeted and dosed radiation to kill cancer cells left behind after your child’s surgery. This treatment is important to control the local growth of tumor.

We usually don’t use radiation therapy unless your child’s tumor has regrown after chemotherapy. Due to the potential long-term 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 the long-term outlook for a child with cerebellar low-grade astrocytoma?

Grade I cerebellar astrocytomas are associated with a 10-year survival rate of 90 to100 percent after surgical removal alone. Grade II cerebellar astrocytomas are more likely to reappear after they’ve been removed by surgery. The survival rate is not as high if the tumor can’t be removed completely during surgery or returns.

What about progressive or recurrent disease?

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

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 cerebellar astrocytomas and other 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 & support

We understand that you may have a lot of questions if your child is diagnosed with a brain tumor. 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 other 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 patients and families.

Learn more about our services. Schedule an appointment or call us at 617-632-2680.