Brain tumors

It’s entirely natural that you might be concerned, right now, about your child’s health; a diagnosis of a brain tumor can be frightening. But you can rest assured that, at Dana-Farber/Children’s Hospital Cancer Center, your child is in good hands. Our physicians are skilled, compassionate and committed to focusing on the whole child, not just his condition.

The good news is that treatment for brain tumors in children has progressed tremendously in the last decade:

• New tools are being used to help doctors diagnose tumors sooner and with more accuracy.
• Radiation therapy and chemotherapy are increasingly targeting tumors more accurately and effectively, while keeping clear of healthy brain cells and tissue.
• A successful new surgical technique is the intra-operative MRI, which gives surgeons a three-dimensional picture of the tumor so they can remove the cancer while leaving other parts of the brain relatively untouched.

What treatments are available for brain tumors?

Your child’s team will determine the best treatment plan based on a number of factors, including, but not limited to:

• your child's age, overall health and medical history
• your child's tolerance for specific medications, procedures or therapies
• type, grade, and location of tumor(s)
• expectations for the course of the cancer
• your opinion or preference

Surgery

Surgery has multiple roles in the diagnosis and treatment of brain tumors, including release of pressure on the brain, biopsy and tumor removal.

If your child has a brain tumor, the first treatment is usually surgery to remove as much of the tumor as possible.

• Tumor specimens are examined by neuropathologists to determine the exact diagnosis.
   
• When possible, it’s best to completely remove the entire tumor. In general, the more of the tumor that is removed, the greater the chance for survival.
  • Most high-grade gliomas cannot be completely removed because of the infiltrating fingers of tumor that characterize their growth.
  • Tumors of the cerebral hemispheres are generally more easily removed than those of the midline, more inner-brain structures.
     
• Using the latest molecular profiling techniques, all pediatric brain tumors are now processed to identify abnormal genes within the tumor (whether due to an inherited condition or a new mutation that occurred to start the tumor)

Radiation therapy

Our doctors use precisely targeted and dosed radiation to kill cancer cells left behind after your child’s surgery. This is important to control the growth of the tumor. Depending on the type of tumor, some patients are treated with targeted focal radiation therapy. In those tumors that may have spread, radiation therapy can sometimes be delivered to the entire brain and spine.

While radiotherapy can be quite effective in treating certain cancers, the radiation damages both cancerous and non-cancerous cells. Because of this, there can be many undesirable side effects during and after treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and, in some cases, prevent these symptoms from occurring.

Chemotherapy

Chemotherapy (“chemo”) refers to drugs that interfere with the cancer cell’s ability to grow or reproduce. For some kinds of tumors, chemotherapy before surgery may help shrink the tumor, making it possible to remove.

• Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
• Often, a combination of chemotherapy drugs is used.
• Certain chemotherapy drugs may be given in a specific order, depending on the type of cancer it is being used to treat.

While chemotherapy can be quite effective in treating certain cancers, the drugs treat cancerous and non-cancerous cells the same. Because of this, there can be many undesirable side effects during treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and, in some cases, prevent these symptoms from occurring.

Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. It may be given:

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

Chemotherapy also refers to the use of drugs that are made to specifically inhibit a molecular pathway required to keep the tumor going. These drugs are often referred to as “targeted” therapy. Rather than the standard side effects associated with radiation and chemotherapy (loss of hair, nausea and vomiting, damage of the blood producing cells), these drugs tend to be much better tolerated.

What is the long-term outlook for a child with a brain tumor?

As with other tumors in both children and adults, surgery is the primary treatment, usually followed by radiation treatment and/or chemotherapy. Unfortunately, because your child’s brain is still developing, these treatments can result in more substantial and permanent side effects than they would for an adult.

Many children who are treated for brain tumors experience significant long-term problems, such as changes in intellectual and motor function. They require ongoing assessment and specialized care to help them function at school and throughout life as best as possible.

Your child’s prognosis greatly depends on:

• the type of tumor
• the extent of the disease
• size and location of the tumor
• presence or absence of metastasis (spreading)
• the tumor's response to therapy
• your child’s age and overall health
• your child’s tolerance for specific medications, procedures or therapies
• new developments in treatment

Today, more than half of all children diagnosed with a brain tumor will be cured of the disease. But with any cancer, prognosis and long-term survival varies greatly. Prompt medical attention and aggressive therapy are very important, as is continuous follow-up care.

Your child may also need a lot of rehabilitation for lost motor skill and muscle strength. If appropriate, he may also see speech therapists and physical and occupational therapists.

New methods are continually being discovered to improve treatment and decrease side effects. For more information on the research, see the Pediatric Brain Tumor Program.

What kind of long-term follow-up care should my child get?

Because of the possible long-term problems and the risk of a tumor returning, assessments and care usually continue for years after the tumor is removed.

One of the major goals of the Dana-Farber/Children’s Hospital Cancer Center Pediatric Brain Tumor Program is to maximize the long-term function of your child. This is achieved through multidisciplinary monitoring and interventions, as needed, in a wide range of areas, including:

• intellectual function and school performance
• endocrine evaluation and treatment
• neurologic assessment
• psychosocial care
• hearing, vision
• ovarian dysfunction in girls
• motor function

After your child’s treatment is complete, your family can find resources to cope with any side effects of treatment through our Stop & Shop Family Neuro-Oncology Outcomes Clinic.

Through the Stop and Shop Neuro-Oncology Outcomes Clinic at Dana-Farber Cancer Institute, your child will be able to meet with his neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit.

• Our pediatric brain tumor survivorship clinic is held weekly.
• In addition to meeting with your pediatric neuro-oncologists, neurologist and neurosurgeon, your child may also see one of our endocrinologists and/or alternative/complementary therapy specialists.
• School liaisons and psychosocial personnel from the pediatric brain tumor team are also available.
• If your child needs rehabilitation, he may also meet with speech, physical, and occupational therapists during and after treatments.

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 resources and support services to help you and your family through this difficult time.