Once a diagnosis has been made, your child’s doctors will then decide on a treatment plan. These plans may range from observation (no need for immediate therapy at all) to a combination of surgery (in which the tumor is physically removed during a surgical procedure), radiation therapy (which uses high-energy particles or waves, such as x-rays, to destroy or damage cancer cells), and chemotherapy (which uses drugs to treat the tumor). Your child’s chance of recovery depends on a number of factors, including tumor type and location, and amount of tumor spread, or metastasis. It is important to note that there are treatments available for every type of brain tumor.
Possible plans include:
- Close observation using physical examination and imaging, which requires no immediate therapy.
- Surgery, in which the tumor is physically removed during a procedure in the operating room.
- Radiation therapy, which uses high-energy particles or waves, such as x-rays, to destroy or damage cancer cells.
- Chemotherapy, which uses drugs to treat the tumor.
- A combination of any of the above.
Young children (those less than three years old) with brain tumors are considered a special treatment group. Regardless of the type of tumor, we often try to avoid radiation therapy on young children due to the risk of causing learning and memory problems in this age group. Chemotherapy is more frequently recommended.
Our Innovative Treatments
In addition to participating in national trials through the Children’s Oncology Group, Memorial Sloan Kettering also offers many of its own unique treatment protocols. Here are some of the advanced treatments we offer our patients with pediatric brain tumors:
- A procedure that uses high-dose chemotherapy with autologous stem cell rescue for appropriate patients with recurrent brain tumors (including medulloblastoma, PNET, and germ cell tumors).
- Patients with recurrent tumors that have spread along the surface of the brain and/or spinal cord (a condition known as leptomeningeal disease) may be eligible for a protocol using a substance known as an intrathecal monoclonal antibody (in this case called 3F8), which is attached to a radioactive form of iodine. The idea is to deliver targeted radiation to the tumor cells, while the normal surrounding structures, which are not targeted, receive very little radiation.
- A radiation oncology treatment called IMRT (intensity modulated radiation therapy) that more tightly focuses the radiation on the tumor, paired with immunotherapy, is being used for most of our patients to reduce the side effects related to radiation therapy, such as cognitive changes, hearing loss, and/or hormonal changes. By reducing the dose of radiation to normal brain tissue, we expect that the risk of these side effects will be reduced. In addition, our doctors have expertise in various forms of radiosurgery. In this process, which uses precise (stereotactic) positioning, computer guidance using MRI scans, and other modern technology, the doctor can deliver high-dose radiation treatments to tumors anywhere in the brain.
- Sophisticated radiology services such as PET scanning; functional MRI scanning, which allows for us to plan surgery that avoids areas of increased brain function; and MR Spectroscopy, a non-invasive tool that identifies the chemical composition of tumors and can aid in diagnosis and prognosis.
- For some childhood brain tumors, our radiation oncologists can use proton therapy, an advanced form of radiation therapy, to deliver high doses of radiation to tumors that may be resistant to conventional forms while minimizing exposure to the surrounding healthy tissues. Proton therapy directs its cancer-fighting energy to precise locations within the body, allowing our doctors to deliver the necessary dose to the tumor — maximizing the chance of destroying it — while simultaneously lowering the dose to normal tissues and thereby reducing the risk of treatment-related side effects. Currently, this cutting-edge technology is available at only 14 locations in the United States.
- Our team is also currently working with partners in laboratories and pharmaceutical industries to test a group of medications known as “targeted agents.” These medications, rather than working like standard chemotherapy drugs, target molecular pathways that are known to be disturbed in cancer cells. These treatments are very early on in development, and always changing.