Treatment

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Treatment and care of children with cancer is usually provided by a team of health professionals called a multidisciplinary team. Members of this team are specialists in children’s cancers – they understand the differences between children’s cancer and adult cancer, and each team member brings different skills in managing care to meet the needs of both you and your child.

The team will be led by a childhood cancer specialist (paediatric oncologist). Other members of the team depend on the age of your child and their type of disease, and may change over time as your child’s needs change. A list of team members who might make up the multidisciplinary team can be found in The treatment team.

Treatment for brain and other CNS tumours depends on the age of your child, the stage of the disease, the biological features of the cancer and other factors identified during diagnosis. Treatment will be tailored to your child’s particular situation, and may involve one or more of the following (see How is cancer treated for more detail).

Surgery

Most children with brain or other CNS tumours have surgery to remove all or part of the tumour. Brain surgery can affect the normal functioning of your child’s brain or nerves. However, the neurosurgeons who perform this surgery are extremely careful to avoid damaging your child’s normal brain tissue.

If the entire tumour can be removed and it has not spread to other parts of the body, your child may not need any other treatment.

If the tumour has spread to surrounding areas, or is in a part of the brain or CNS that makes complete removal of the tumour very difficult, surgery can still be used to remove as much of the tumour as is safely possible. This reduces the size of the tumour that needs to be treated with chemotherapy or radiation therapy, and may make these treatments more successful.

Reducing the size of the tumour through surgery can reduce pressure on the brain, which can help to relieve symptoms such as headaches, nausea, seizures and blurred vision.

Surgery can also be used to drain excess fluid to relieve pressure on the brain, or to insert a device that allows chemotherapy to be delivered directly into the cerebrospinal fluid (known as a ventricular access catheter).

After surgery, your child may have one or more tubes coming out of the surgical site to drain excess fluid out of the skull. These tubes are usually removed after a few days.

Chemotherapy

Chemotherapy uses anti-cancer medicines to destroy cancer cells. It is often given as a combination of medicines to try to prevent the cancer cells from becoming resistant to just one or two medicines.

Chemotherapy medicines are given together in courses, often over a few days. Once the body has recovered from the side effects, the next course is given. Most children receive multiple courses of chemotherapy .

Chemotherapy may be used for brain and other CNS tumours:

  • after surgery (to destroy any remaining cancer cells)
  • as the main treatment (if surgery is not a good option, or to avoid or delay using radiation therapy, or along with radiation therapy)
  • in high doses with stem cell support (i.e. high-dose chemotherapy followed by a stem cell transplant).

Chemotherapy for many types of cancer is usually given intravenously (IV) or by mouth. For brain and other CNS tumours, chemotherapy can also be given directly into the cerebrospinal fluid through a ventricular access catheter, which is inserted during an operation. This device has a small tube that passes into the area of the brain where the cerebrospinal fluid flows. The treatment team can inject chemotherapy medicines directly into it, and also take samples of fluid out of it to run tests.

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy X-rays or other types of radiation to destroy cancer cells or stop them from growing.

Radiation therapy may be used:

  • after surgery (to destroy any remaining cancer cells)
  • as the main treatment (if surgery is not a good option or chemotherapy does not stop the tumour growing)
  • to relieve symptoms of the tumour.

Children and adults may have the same total dose of radiation to treat brain and other CNS tumours, but children may have smaller doses spread over a few days. Depending on where the tumour is and whether it has spread, high doses of radiation can be aimed precisely at the tumour, which limits the amount of radiation to other areas of the body. If a tumour has spread or has the potential to spread throughout the CNS, radiation may be given to the entire brain and spinal column.

Radiation therapy is not commonly used to treat brain and other CNS tumours in children under 3 years of age because it can have long-term side effects on developing brains. Young children usually have chemotherapy instead, and may have radiation therapy once they are old enough. If radiation therapy is included in your child’s treatment, special care will be taken to reduce the risks.

Radiation therapy can affect your child’s learning abilities. They will have regular assessments for learning disabilities throughout their childhood.

Targeted therapy

Some medicines can target the specific changes in cancer cells that make them different from normal cells. This means that they work differently from standard chemotherapy, and they usually have fewer side effects, or the side effects are not as severe.

A medicine called everolimus can be used for a particular type of brain and CNS tumour called subependymal giant cell astrocytoma (SEGA) to shrink it or slow its growth. It is taken as a tablet once a day.

Monoclonal antibodies (such as bevacizumab) are given intravenously, and can be used to kill cancer cells, slow their growth, or deliver medication directly to the cancer site.

Targeted therapies are usually given in combination with other treatments such as chemotherapy or surgery. Many targeted therapies are experimental and are only used in clinical trials.

Other treatments

Some treatments do not treat the tumour itself, but can help relieve symptoms that result from the tumour or the treatment. Common treatments of this kind include:

  • corticosteroids, which can help reduce swelling in the skull, and reduce headaches, nausea and vomiting
  • medicines that can reduce the chance of your child having seizures
  • hormones that can restore your child’s hormone balance if the tumour or the treatment has affected their pituitary gland (which controls hormone levels in the body).

Careful observation

If your child has a tumour that is not growing or spreading, they might be monitored closely but not given any treatment until they develop symptoms, or until their symptoms change. Careful observation is sometimes used for some low-grade gliomas.

published: Sunday, 23 August, 2015