The different types of standard treatments for childhood brainstem glioma are explained. Standard treatments are used along with the integration of effective treatment planning. Clinical trials are used as an innovative treatment approach that combines different therapies and drugs for treating brainstem glioma in children. Children with neurofibromatosis type 1 (NF1) are recommended to undergo active surveillance or watchful waiting for signs of worsening the tumour. The standard treatment for brainstem glioma in children includes radiation therapy, chemotherapy, surgery, and palliative care. Standard methods for chemotherapy include an intravenous (IV) tube placed into a vein using a needle or by capsule or pill taken orally. Children having diffuse types of brain stem glioma are not recommended for surgery because of the position of the tumor and the risk involved. Palliative care is provided to the patients to cope with mental, physical or financial issues while involving medication, nutritional changes, emotional and spiritual support and other relaxation therapies
Treatment of Brainstem Glioma – Childhood
Generally, tumors in children are uncommon. Doctors can plan the Types of Treatment for Brain Stem Glioma if they know what has been most influential in children. Around 60% of the children are treated as a part of clinical trials.
A pediatric oncologist is a doctor who exclusively treats children with cancer. For brain stem glioma, a neuro-oncologist is also involved in the treatment. A neuro-oncologist specializes in CNS tumors.
In cancer care, different doctors work together to bring out an overall treatment plan for the patient. It is called a multidisciplinary team.
Treatment options and recommendations are grounds on several factors, including the type and grade of the tumor, possible side effects, the family’s preferences, and the child’s overall health 1.
The Types of Treatment for Brain Stem Glioma for children with brain stem glioma having a genetic condition neurofibromatosis type 1 (NF1) may differ. A tumor in a child having NF1 may be low-grade, although it appears diffuse. Therefore, an approach called ‘active surveillance’ or ‘watchful waiting’ can be recommended in which the patient is sharply monitored to watch for signs that the tumor is worsening 2. Treatment would begin if the tumor started to grow and spread.
Details of the common Types of Treatment for Brain Stem Glioma are listed below.
Radiation therapy uses high-energy X-rays or particles to destroy cancer cells. Radiation therapy is the most regular treatment for brain stem glioma.
The most common radiation treatment type is external-beam radiation therapy, in which radiation is given from the machine outside the body. A radiation therapy schedule consists typically of a specific number of treatments offered over a set period.
A newer radiation therapy that can be an option for children with brain stem glioma is proton beam therapy and external-beam radiation therapy that uses protons instead of x-rays. Protons at high energy can destroy cancer cells.
Side effects of radiation therapy include mild skin reactions, fatigue, loose bowel movements and upset stomach. Most side effects diminish soon after treatment is concluded. The doctor may choose to treat the tumor differently because radiation therapy can probably cause difficulty with the growth and development of the child’s brain. The doctor may first use chemotherapy to shrink the tumor to avoid or lessen the need for radiation therapy in young children.
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Chemotherapy uses medicine to kill or stop the growth of cancerous cells. Depending upon the stage, different chemotherapy is given. The point that makes a difference is how the chemotherapy enters the body and which cells it affects.
Systemic chemotherapy enters the bloodstream to reach cancerous cells all over the body.
Standard methods for chemotherapy include an intravenous (IV) tube placed into a vein using a needle or by capsule or pill taken orally.
A chemotherapy schedule usually consists of a certain number of cycles over a fixed period. A patient can be given one drug at a time or a combination of different medications given simultaneously.
Chemotherapy may not be an effective treatment for brain stem glioma itself 3. A doctor can use chemotherapy treatment before, during, or after radiation therapy.
The side effects of chemotherapy usually depend on the person and the dose used. Still, they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhoea. These side effects typically go away after treatment ends.
It is also essential to let your doctor know if you are taking any over-the-counter medications, other prescriptions or supplements because herbs, supplements, and other drugs can interact with cancer medications.
Surgery is the removal of a tumor and surrounding healthy tissue during an operation. A neurosurgeon specializes in treating a CNS tumor using surgery. Surgery can only treat brain stem glioma when the tumor looks focal on an MRI scan. Removing the tumor without damaging the brain can be possible, such as when a tumor grows out from the brain stem instead of into the brain stem.
For children with diffuse types of brain stem glioma, surgery is not recommended or possible because of the position of the tumor and the risk involved. This type of tumor may be called inoperable or unresectable.
A CNS tumor and its treatment cause physical symptoms, side effects, and emotional, financial, and social effects. Managing all of these effects is called supportive or palliative care. An essential part of your child’s care is included with treatments intended to slow, stop, or eliminate the tumor.
Palliative care includes medication, nutritional changes, emotional and spiritual support and other relaxation therapies.
Palliative care focuses on alleviating how you feel during treatment by managing symptoms and supporting patients and their families with other non-medical needs. Regardless of type and stage of Cancer age, any person may receive this type of care.
Remission and the chance of recurrence
When cancer can’t be detected in the body and there are no symptoms, this is known as remission. It may also be called having ‘no evidence of disease’ or ‘NED.’
A remission can be temporary or permanent. Many people worry about the recurrence of cancer.
If the tumor returns after the original treatment, it is called a recurrent tumor. It may return in the same place (local recurrence), nearby (regional recurrence), or in another area (distant recurrence).
Treatment for recurrent brain stem glioma usually depends on the type of tumor, such as focal or diffuse, and the treatment is given for the original tumor. Based on the situation, the doctor may recommend either surgery or chemotherapy. The child’s doctor may also suggest clinical trials studying new ways to treat this type of recurrent tumor.
If treatment doesn’t work
Typically, the Types of Treatment for Brain Stem Glioma is successful for many children with a CNS tumor; sometimes, it is not. If cancer can’t be treated or controlled, it leads to advanced or terminal cancer. It is vital to have straightforward conversations with your health care team to express your feelings, preferences, and concerns. The health care team has unique skills, knowledge, and experience to assist patients and their families. Ensuring that a person is physically comfortable, free from pain, and emotionally supported is extremely important.
- 1.MacDonald TJ, Aguilera D, Kramm CM. Treatment of high-grade glioma in children and adolescents. Neuro-Oncology. Published online July 22, 2011:1049-1058. doi:10.1093/neuonc/nor092
- 2.Voelker R. A New Treatment for Children With Neurofibromatosis Type 1. JAMA. Published online May 19, 2020:1887. doi:10.1001/jama.2020.7157
- 3.Freeman CR, Perilongo G. Chemotherapy for brain stem gliomas. Child’s Nervous System. Published online October 15, 1999:545-553. doi:10.1007/s003810050542