Treatment
Treatment for brain tumors depends on factors including the tumor’s type, grade, size, location, and whether it has invaded other parts of the brain. Treatment for brain tumors may include surgery, chemotherapy, radiation therapy, and targeted therapy. The doctor will develop a specific treatment plan for a child, depending on the specific characteristics of the tumor. Here are some treatments the doctor may recommend for brain tumors in children:
Surgery
Surgery is the primary treatment for most brain tumors. Even when the cancer is widespread and aggressive, the doctor will still perform surgery to remove as much of the tumor as possible and take a biopsy sample. This may help relieve symptoms and prevent complications caused by the tumor pressing on or invading healthy tissue. Removing as much tumor as possible may also help chemotherapy and radiation treatments to be more effective. In general, the more tumor removed, the better the chance of survival. The most common surgery for brain tumors is a craniotomy, in which a neurosurgeon removes a part of the skull and removes the tumor through the hole. After a craniotomy, the doctor usually closes the hole by securing the piece of bone with metal clips. Extent of surgical resection correlates with prognosis and thus maximal resection is performed without causing significant morbidity. Tumors in the brain stem and optic pathway are usually not biopsied as these are in very eloquent areas of the brain.
Cerebrospinal fluid diversion
The cerebrospinal fluid diversion is a procedure used to drain excess fluid from the brain. A long thin tube called a shunt is positioned in the ventricle (fluid-filled space) in the brain and placed under the skin to a different part of the body, usually the abdomen. This shunt moves the extra fluid away from the brain so it may be absorbed in another part of the body.
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Radiation Therapy
Radiation therapy uses waves of high energy rays to target and kill cancer cells. External radiation which uses a machine outside of the body to send radiation towards the cancer or internal radiation which uses a radioactive substance and places it directly into or near the cancer may be used to treat brain tumors. Many brain tumors form in deep or delicate parts of the brain that make them impossible to remove without causing serious damage. Doctors often use radiation therapy as the primary treatment for brain tumors that can't be surgically removed. Doctors may also use radiation therapy to kill any cancer cells that were not removed in surgery. Radiation therapy is not usually recommended for very young children under the age of 3 because it can damage the developing brain. These children are typically treated with surgery and chemotherapy. There are many new and advanced radiation therapy techniques that allow the doctor to target brain tumors more precisely without damaging as much healthy tissue. With the advent of these new technologies, radiation techniques such as 3D-CRT may even be given to children under 3 years of age for some specific tumors like ependymomas.
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Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Most conventional chemotherapy drugs are not effective against brain tumors because they poorly penetrate the blood-brain barrier (BBB). The doctor may use some forms of chemotherapy in combination with surgery and radiation therapy to treat some aggressive tumors or use high dose chemotherapy to circumvent the (BBB). For a brain tumor, a child may receive chemotherapy orally or intravenously, or the doctor may place several wafers (chemotherapy discs) near the tumor after surgery. These wafers release chemotherapy drugs into the brain slowly as they dissolve, however placement of wafers has been studied more in adults. Direct infusion of chemotherapy into the area of the brain tumor using a catheter placed post-surgically is now also being used in some cases. This allows the doctor to concentrate the drug at the tumor site so it doesn't cause side effects throughout the body when delivered peripherally through a vein.
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Targeted Therapy
Over the last decade, improved understanding of the biology of different brain tumors have allowed physicians to identify over-expressed genes and proteins which drive tumor formation. Current research is focusing on developing therapies to target these key players responsible for tumor formation.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials (Phase I) are often used to test side effects of a drug or drug combination, while later phase clinical trials (Phase II or III) are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
Clinical trials are more commonly used for recurrent, refractory tumors that continue to have a poor outcome after using conventional therapeutic strategies. Currently, high-dose chemotherapy with stem cell transplant is being studied in clinical trials in hopes of future use in the treatment of childhood brain tumors.
