Childhood brain and spinal tumours

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Brain stem glioma

Brain stem gliomas are a type of glioma that starts in the brain stem. They often grow in the middle of the brain stem and are difficult to remove with surgery. Most brain stem gliomas are pontine gliomas, which start in the part of the brain stem called the pons.

Types of brain stem gliomas

The 2 main types of gliomas that occur in children are focal or low-grade gliomas and diffuse gliomas.

Focal brain stem glioma occurs in one area or is contained within a small part of the brain stem. It is usually benign or low grade and is less aggressive.

Diffuse intrinsic pontine glioma (DIPG) often spreads throughout the brain stem and to other parts of the brain. It tends to be a high-grade tumour and is very aggressive. DIPG may also be called diffuse brain stem glioma.

A recurrent brain stem glioma is a tumour that has come back after treatment.

Treatment of brain stem gliomas

Treatment of brain stem gliomas depends on:

  • the grade or type of tumour
  • the size and location of the tumour
  • whether or not the child has neurofibromatosis
  • whether the cancer has spread to other areas of the brain
  • the child’s age, neurological condition and general health

Treatment of brain stem gliomas in children with neurofibromatosis may differ. Tumours may be low grade even if they look diffuse. Active surveillance may be used to watch the tumour and treatment will begin if the tumour starts to grow or spread.

Treatment of focal brain stem gliomas

Some focal brain stem gliomas grow so slowly that treatment might not be needed unless the tumour causes problems. If treatment is needed, surgery is the main treatment used for focal or low-grade brain stem gliomas. Doctors will try to remove as much of the tumour as possible. Radiation therapy or chemotherapy or both may be used after surgery. If surgery is not possible, radiation therapy or chemotherapy or both may be used to treat the tumour.

Recurrent focal brain stem gliomas may be treated with surgery, radiation therapy or chemotherapy or a combination of these treatments. Chemotherapy drugs used for recurrent focal brain stem gliomas include carboplatin (Paraplatin, Paraplatin AQ) and vincristine (Oncovin).

Treatment of diffuse intrinsic pontine gliomas (DIPGs)

Radiation therapy is the most common treatment for diffuse brain stem gliomas because most of these tumours cannot be removed with surgery. Surgery is not usually recommended for most DIPGs because it would be too dangerous and would likely do more harm than good.

There is no standard treatment for recurrent diffuse brain stem gliomas. Doctors may suggest that the child enrol in a clinical trial.

Clinical trials

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

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