Central nervous system tumor - childhood cancer: Treatment options

Central nervous system tumor - childhood cancer: Treatment options

ON THIS PAGE: You will learn about the different ways that doctors use to treat children with a CNS tumor. To see other pages, use the menu.

In general, tumors in children are rare. This means that it can be difficult for doctors to plan treatments, unless they know which was the most effective in other children. For this reason, more than 60% of children receive treatment as part of a clinical trial. Clinical trials are research studies that compare standard care treatments with newer treatment approaches that may be more effective. The "standard of care" refers to the best known treatments. Clinical trials can test such approaches, as in the case of a new drug, a new combination of standard treatments, or new doses of current therapies. The health and safety of all children participating in clinical trials are carefully monitored.

To benefit from these newer treatments, children with a CNS tumor should receive treatment at a specialized cancer center. The doctors in these centers have vast experience in the treatment of children and have access to the latest research. The doctor who specializes in the treatment of children with a tumor is known as a pediatric oncologist. If a pediatric cancer center is not nearby, general cancer centers sometimes have pediatric specialists who can participate in your child's care.
General description of the treatment

In many cases, a team of doctors works with a child and family to provide care; this is known as a multidisciplinary team (in English). Pediatric cancer centers often have additional support services for children and their families, such as childhood specialists, dietitians, physiotherapists and occupational therapists, social workers and counselors. There may also be special activities and programs available to help your child and his family cope.

The most frequent treatment options for a CNS tumor are described below. The options and recommendations regarding the treatments depend on several factors, among them, the type of tumor of the CNS, if it is cancerous, the stage and / or the grade of the tumor, the possible side effects as well as the preferences of the family. , the child's age and general health status. For example, radiotherapy is usually limited in children under three years of age, because its application on large surfaces can cause learning and memory problems in the future. Your child's care plan may also include treatment for symptoms and side effects, an important part of medical care. Take the time to know all the treatment options for your child and be sure to ask questions if you have questions about things that are unclear. Also, talk about the goals of each treatment with your child's doctor and what you can expect during treatment.

Type of CNS tumor

Most used treatment

Astrocytoma

Low-grade astrocytoma: surgery alone, or surgery plus radiation therapy, or radiation therapy alone for larger children; surgery plus chemotherapy or limited radiotherapy for younger children.

High grade astrocytoma: surgery plus radiotherapy and chemotherapy.

Brain stem glioma

Radiation therapy, with or without chemotherapy.

Ependymoma (in English)

Surgery and radiotherapy; possibly chemotherapy.

Germ cell tumor (in English)

Surgery and radiotherapy, with or without chemotherapy.

Medulloblastoma (in English)

Surgery, radiotherapy and chemotherapy.

Learn more about making treatment decisions (in English).
Surgery

Surgery is the removal of the tumor and part of the surrounding healthy tissue during an operation. In almost all cases, it is used to find out the type of tumor, either through a biopsy or during treatment when the tumor can be excised without significant damage to the brain (brain). A neurosurgeon is a doctor who




    

specializes in the treatment of tumors hosted in the brain (brain) or in the spine by surgery. Sometimes, surgery is more difficult because the tumor spreads and grows between healthy nerve cells. In certain situations, surgery can damage parts of the brain (brain) near the tumor and, thus, affect arm and leg movement, breathing, swallowing, eye movement or awareness. Learn more about the basics of surgery.

Some tumors can not be removed by surgery because of their location. These tumors are called inoperable or non-resectable. In these cases, the doctor will recommend other treatment options.
Radiotherapy

Radiotherapy is the use of x-rays or other particles with high potency to eliminate tumor cells. The doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called external beam radiation therapy, which is radiation delivered from a machine external to the body. When radiation treatment is given using implants, the treatment is called internal radiotherapy or brachytherapy. A regimen (program) of radiotherapy, usually, consists of a specific amount of treatments that are administered in a certain period.

Stereotactic radiosurgery is a way to apply high doses of radiation therapy directly to a tumor, avoiding healthy tissues. This technique produces detailed three-dimensional maps of the brain (brain) and tumor, so that doctors can locate exactly where to direct the radiation treatment. It works best for certain non-cancerous tumors and tumors that only occupy part of the brain (brain).

Another type of radiation therapy used for a CNS tumor is proton therapy. Proton therapy is a type of external-beam radiation therapy that uses protons instead of X-rays. With high potency, protons can destroy tumor cells. Proton therapy is increasingly being used in the United States.

Learn more about the basics of radiation therapy. Side effects of radiation therapy can include fatigue, mild skin reactions, upset stomach, headache, and loose stools. Most side effects disappear shortly after the end of treatment. However, in the long term, radiation therapy can sometimes cause problems in the growth and development of the child's brain. Therefore, the doctor may choose to treat the tumor in another way.
Chemotherapy

Chemotherapy is the use of drugs to destroy tumor cells, usually by inhibiting their ability to grow and divide. The professional who administers this treatment is a clinical oncologist, a doctor who specializes in the treatment of tumors with medications.

Systemic chemotherapy enters the bloodstream to reach tumor cells throughout the body. Some common methods of chemotherapy include an intravenous (IV) tube that is placed in a vein with a needle, or a pill or capsule that is swallowed (orally). Chemotherapy can also be administered directly into the spinal canal, in a procedure called intrathecal chemotherapy, to treat tumor cells that are found on the surface of the brain (brain) and spine. This procedure is still being investigated in clinical trials and may not be available to the general public.

A chemotherapy regimen usually consists of a specific number of cycles that are administered within a certain period of time. A patient can receive 1 drug at a time or combinations of different drugs at the same time.

Chemotherapy is effective for many types of cancerous brain tumors. Depending on the type of tumor, chemotherapy can be given immediately after a biopsy or surgery or after radiation therapy. In some cases, chemotherapy is used simultaneously with radiation therapy.

The side effects of chemotherapy depend on the patient and the drug and the dose used, but may include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea. These side effects usually disappear once the treatment is finished.




  
Learn more about the basics of chemotherapy and how to prepare for treatment. The medications used to treat a tumor are constantly evaluated. Often, talking with your child's doctor is the best way to learn about the medications they prescribed, their purpose and possible side effects or interactions with other medications. Get more information about the medications your child was prescribed in the databases (in English) of drugs in which you can search.
How to get care for symptoms and side effects

A CNS tumor and its treatment often cause side effects. In addition to treatment to slow, stop or eliminate the disease, an important aspect of care is to alleviate the symptoms and side effects of the child. This approach is called palliative care or supportive care, and includes supporting the child with his / her physical, emotional, and social needs.

Palliative care is any type of treatment that focuses on reducing symptoms, improving the quality of life and providing support to patients and their families. Anyone, regardless of age or type and stage of cancer, can receive palliative care. Palliative care works best when it starts as soon as possible in the treatment process. Often, children receive treatment for the tumor and treatment to decrease side effects at the same time. In fact, patients who receive both treatments often have less severe symptoms, better quality of life and families report that they are more satisfied with the treatment.

Palliative treatments vary widely and often include medications, nutritional changes, relaxation techniques, emotional support and other therapies. Your child can also receive palliative treatments similar to those used to remove the tumor, such as chemotherapy, surgery or radiation therapy. Talk with your child's doctor about the goals of each treatment plan treatment.

Before starting treatment, talk to your child's health care team about possible side effects of your child's specific treatment plan and hospice options. Also, during and after treatment, be sure to tell your doctor or another member of the health care team if your child is having a problem so that it can be addressed as soon as possible. Get more information about palliative care.
Remission and the possibility of recurrence

A remission occurs when the tumor can not be detected in the body and there are no symptoms. This can also be called "no evidence of disease" (NED).

A referral can be temporary or permanent. This uncertainty makes many people worry that the cancer will return. Although many remissions are permanent, it is important to talk to your doctor about the possibility of the tumor coming back. Understanding your child's recurrence risk and treatment options can help you feel more prepared if, in effect, the tumor comes back. Learn more about coping with the fear of recurrence (in English).

If the tumor returns after the original treatment, it is called a recurrent tumor. It can reappear in the same place (which is called local recurrence), in the vicinity (regional recurrence) or elsewhere (recurrence at a distance).

When this happens, a test cycle will begin again to obtain as much information as possible about the recurrence. After the tests are done, you and your child's doctor will discuss treatment options. Often, the treatment plan will include the treatments described above, such as surgery, chemotherapy and radiation therapy, but they may be combined in a different way or administered at a different frequency. Your child's doctor may also suggest clinical trials that are studying new methods to treat this type of recurrent tumor. Whichever treatment plan you choose, palliative care will be important to alleviate symptoms and side effects.

For a recurrent CNS tumor, the next phase of treatment depends on three factors:



The type of tumor

    If the tumor has reappeared in the place of origin or in another part of the brain (brain) or body.

    The type of treatment administered for the original tumor.

Depending on your child's situation, the doctor may recommend surgery, radiation therapy, chemotherapy, and / or stem cell / bone marrow transplant.

A recurrent tumor can generate emotions such as disbelief or fear. It is recommended that you and your family members talk to your health care team about these feelings and request support services to help them cope. Get more information on how to cope with the recurrence of a tumor (in English).
If the treatment fails

While the treatment is successful for most children with a tumor, sometimes it is not. If a child's tumor can not be cured or controlled, this is called an advanced or terminal tumor. This diagnosis is stressful, and it can be difficult to talk about an advanced CNS tumor. However, it is important to have open and honest conversations with the doctor and the health care team in order to express the feelings, preferences and concerns of your family. The health care team aims to help, and many of its members have special skills, experience and knowledge to support patients and their families.

Parents or guardians are encouraged to think about where the child will be most comfortable: at home, in a home-like environment elsewhere, in the hospital, or in a hospice. Hospice care is a type of palliative care for people with a life expectancy of less than 6 months. It is designed to provide the best possible quality of life for people who are near the final stage of life. Nursing care and special equipment can make staying at home a feasible alternative for many families. Some children can be happier if they can arrange to attend school part-time or continue doing other activities and social connections. The child's health care team can help parents or guardians decide the appropriate level of activity. Making sure a child is physically comfortable and does not feel pain is a very important part of end-of-life care. Learn more about how to care for a child with a terminal illness and planning for advanced care.

The death of a child is a huge tragedy and families may need support to cope with this loss. Pediatric cancer centers often have professional staff and support groups to assist in the grieving process. Get more information about grieving for the loss of a child (in English).

The next section of this guide is about clinical trials. It offers more information about research studies that focus on finding better ways to care for people with a CNS tumor. Or, use the menu to choose another section, so continue reading this guide.