Childhood brain and spinal tumours

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Astrocytoma

Astrocytomas are a type of glioma that starts in glial cells called astrocytes. Astrocytes support and protect neurons in the central nervous system (CNS). Astrocytomas are found in the cerebellum, cerebrum, central areas of the brain, brain stem and spinal cord.

Grading

Astrocytomas can be classified as low or high grade depending on how the tumour cells look and how quickly they grow and spread.

Low grade means they are growing slowly. Low-grade astrocytomas have cells that look similar to normal CNS cells and are a type of benign brain tumour. Most low-grade tumours are grade I tumours (called pilocytic astrocytoma or juvenile pilocytic astrocytomas). Some are grade II (called diffuse astrocytoma or fibrillary astrocytomas).

High grade means they are growing rapidly. The most common grade III tumour is anaplastic astrocytoma, and the most common grade IV tumour is glioblastoma (also called glioblastoma multiforme or GBM).

Low-grade and high-grade astrocytomas are treated very differently. Most astrocytomas in children are low-grade.

A recurrent astrocytoma is a tumour that has come back after treatment.

Treatment of low-grade astrocytomas

Low-grade astrocytomas include both grade I and grade II tumours. A low-grade astrocytoma may turn into an anaplastic astrocytoma.

Treatment of low-grade astrocytomas depends on:

  • the size and location of the tumour
  • how far the tumour has grown or spread
  • whether the tumour can be surgically removed (resectable)
  • the child’s age, neurological condition and general health

Surgery

Surgery is the main treatment for low-grade astrocytomas that can be easily removed. The goal is to remove as much of the tumour as possible. If the doctor can remove all of the tumour, no further treatment may be needed. If the tumour can’t be completely removed, other treatments can be used, such as radiation or chemotherapy.

Radiation therapy

Radiation therapy may be used to treat tumours that:

  • are difficult to remove with surgery (those in the brain stem, near the optic nerves, in the hypothalamus or thalamus)
  • have been partially removed but could cause neurological problems if they regrow

Doctors usually avoid giving radiation to children under 3 years old because it can damage developing brain cells. In these cases, the doctors will:

  • postpone giving radiation until the child is older
  • give chemotherapy first and radiation later, if needed
  • avoid radiation altogether and monitor the child closely to see if the tumour comes back

Chemotherapy

Chemotherapy may be used when radiation therapy has to be delayed. The most common chemotherapy drug combinations used to treat low-grade astrocytomas are:

  • carboplatin (Paraplatin, Paraplatin AQ) with or without vincristine (Oncovin)
  • thioguanine (Lanvis, 6-TG), procarbazine (Matulane), lomustine (CeeNU, CCNU) and vincristine

Active surveillance

Active surveillance may be used for some tumours. Sometimes, a low-grade tumour can’t be completely removed with surgery. In these cases, active surveillance may be a treatment option. The child will be watched closely after surgery for any additional tumour growth. If the tumour starts growing again, more treatment will be needed. However, unlike other brain tumours, some children with remaining (residual) low-grade astrocytomas may survive a long time without any symptoms or tumour regrowth even without additional treatment after surgery.

Treatment of recurrent low-grade astrocytomas

Treatment for recurrent low-grade astrocytomas depends on:

  • the location and size of the tumour
  • whether the tumour is causing symptoms
  • what treatment was used before

Treatment may include a second surgery, observation, radiation therapy, chemotherapy or targeted therapy. These treatments may be given alone or in combination. Surgery may be used to remove the tumour. If the tumour is unresectable, radiation or chemotherapy may be used. Chemotherapy will be used if radiation was previously used or the child is under 3 years old. Targeted therapy may also be given with chemotherapy.

Chemotherapy drugs for recurrent low-grade astrocytomas include:

  • vinblastine (Velbe)
  • temozolomide (Temodal)
  • temozolomide, carboplatin and vincristine
  • bevacizumab (Avastin) and irinotecan (Camptosar)

Treatment of high-grade astrocytomas

High-grade astrocytomas include both grade III and grade IV tumours. Treatment of high-grade astrocytomas depends on:

  • the size and location of the tumour
  • how far the tumour has grown or spread
  • the child’s age, neurological condition and general health

Surgery

Surgery is the main treatment for high-grade astrocytomas. The neurosurgeon will try to remove as much of the tumour as possible without damaging the surrounding healthy tissue. Complete removal of the tumour may result in a more favourable prognosis. If the tumour is in a place where it can’t be removed with surgery, the doctor will try to get a biopsy of the tumour to find out its type and grade. Surgery is usually followed by radiation therapy, with or without chemotherapy.

Radiation therapy

Radiation therapy is usually given after surgery. It will be directed to the area immediately surrounding the tumour and sometimes to the whole brain. It may also be given as the main treatment, with or without chemotherapy, if surgery cannot be done. In children under 3 years old, radiation can damage developing brain cells. In these cases, doctors will try to delay giving radiation until the child is older.

Chemotherapy

Chemotherapy may be given as part of the treatment for high-grade astrocytomas. It may be given along with radiation therapy to make radiation therapy more effective. Children under 3 years old may be treated with chemotherapy to delay giving radiation therapy until they are older.

The chemotherapy drug that is usually used first to treat high-grade astrocytoma is temozolomide (Temodal). Other chemotherapy drugs used to treat high-grade astrocytomas include:

  • carmustine (BiCNU, BCNU)
  • lomustine
  • cisplatin (Platinol AQ)
  • procarbazine (Matulane)
  • vincristine

The most common chemotherapy drug combination used to treat high-grade astrocytoma is PCV (procarbazine, lomustine and vincristine).

Targeted therapy

Targeted therapy is sometimes used along with chemotherapy to treat high-grade astrocytoma.

Treatment of recurrent high-grade astrocytomas

Treatment for recurrent high-grade astrocytomas depends on:

  • the location and size of the tumour
  • what treatment was used before

Treatment options for recurrent high-grade astrocytomas include surgery, targeted therapy and high-dose chemotherapy with stem cell transplant. If radiation therapy wasn’t used in previous treatment, surgery and radiation therapy may be used. If the child already had radiation therapy, surgery and chemotherapy may be used. Doctors may suggest that the child enrol in a clinical trial.

Clinical trials

Many children with astrocytomas are treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Stories

Rosemary Pedlar After seeing a Canadian Cancer Society call for volunteers in a newspaper, Rosemary knew that this was her opportunity to get started.

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