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These tumors tend to grow slowly, but they can grow into nearby tissues. The initial treatment is surgery, if possible, or a biopsy to confirm the diagnosis if surgery cannot be done. Because these tumors often grow into nearby normal brain tissue, they are hard to cure with surgery alone. Usually, the surgeon will try to remove as much of the tumor as safely possible. If the surgeon can remove it all, the child may be cured with no further treatment.

Radiation therapy may be given after surgery, especially if a large amount of tumor remains. Otherwise, radiation may be postponed until the child is older or the tumor starts to regrow. Sometimes, a second surgery might be tried before giving radiation. Radiation may also be used as the main treatment if surgery is not a good option because of the tumor’s location.

If the child is young and the tumor is in a part of the brain the surgeon can’t reach easily, chemotherapy may be given to try to treat the tumor or at least delay the need for radiation therapy.

Depending on whether there are certain gene changes in the tumor cells, other targeted therapies may be used. For example, tumors with BRAF V600E may benefit from dabrafenib and trametinib. Tumors with gene changes in NTRK, ROS1, ALK, or FGFR1/2/3 may respond to entrectinib or larotrectinib.

Optic pathway gliomas (OPGs) are a unique type of low grade glioma seen more commonly in children and teens with neurofibromatosis type 1 (NF1). Surgery, chemotherapy, and targeted therapy are treatment options, depending on the location and size of the tumor, and whether it affects vision and other functions. Radiation may also be an option but is often avoided in people with NF1.

These tumors have cells that divide quickly and grow into surrounding normal brain tissue more easily. This can make them more difficult to treat.

When surgery is used, as much of the tumor as possible is removed, and then radiation therapy is given.

If surgery cannot be done, radiation is the main treatment.

If the child is younger than 3, radiation may be postponed until they are older by using chemotherapy or targeted therapy. Surgery may be repeated in some cases if the tumor comes back after the initial treatment.

Diffuse intrinsic pontine glioma (DIPG, also called diffuse midline glioma or DMG) is a specific type of high-grade glioma. This tumor has a specific gene change (H3 K27M) and is very difficult to treat. Because of its location in the brainstem or middle regions of the brain, surgery is not a good option. Radiation therapy can help slow tumor growth, but the tumor often regrows. A new targeted drug called dordaviprone may be an option for tumors that grow after radiation treatment.

Because these tumors are hard to cure with current treatments, clinical trials of promising new treatments may be a good option. For example, some clinical trials are studying whether immunotherapy will be helpful for high grade gliomas with many gene changes.

This type of glioma grows slowly and does not grow into surrounding normal brain tissue, which makes it easier for surgeons to remove the entire tumor.

Pilocytic astrocytomas occur most often in the cerebellum in young children, while subependymal giant cell astrocytomas (SEGAs) grow in the ventricles and are almost always seen in people with tuberous sclerosis.

Children and teens with these astrocytomas may be cured by surgery alone. If the tumor is not removed completely, they may be given radiation therapy or chemotherapy as well, although doctors might wait until there are signs the tumor is growing back before considering other treatment. Even then, another surgery to remove the remaining tumor may be the first option. The outlook is not as good if the tumor is in a place that does not allow it to be removed surgically, such as the hypothalamus or brain stem. In these cases, chemotherapy, targeted therapy, or, in older children and adolescents, radiation therapy may be the best options.

For SEGAs that cannot be removed completely by surgery, treatment with the targeted drug everolimus (Afinitor) might shrink the tumor or slow its growth for some time.

Surgery is an important part of treatment for these tumors. Complete removal of the tumor may cure low-grade tumors. If the tumor cannot be completely removed with surgery, doctors may monitor it with imaging tests to see if it keeps growing before considering more treatment. If needed, radiation therapy, chemotherapy (especially in younger children, where radiation should be avoided or delayed), and targeted therapies may also be options.

These tumors most commonly grow in the back part of the skull (called the posterior fossa) near the brain stem. They can also grow in the spinal cord or the cerebrum. While these tumors do not usually grow into nearby normal brain tissue, they can be near important parts of the brain, which can make them hard to remove. They can sometimes be cured by surgery if the entire tumor can be removed, but this is not always possible. If some of the tumor must be left behind, a second operation may be done in some cases, often after a short course of chemotherapy, to try to remove the rest of it.

Radiation therapy is recommended after surgery for most children and teens to try to prevent the tumor from coming back, even if it appears that all of the tumor has been removed. Radiation may be given to the spine if tumor cells are found in the cerebrospinal fluid (CSF) or if the tumor looks like it is growing on the surface of the nervous system (leptomeningeal disease) on imaging tests.

Targeted drugs are being investigated. Unfortunately, targeted treatments like bevacizumab and lapatinib, which showed some benefit in adult trials, do not seem to work as well in children with recurrent ependymoma.

Embryonal tumors tend to grow quickly and spread to the cerebrospinal fluid (CSF). In the past, many embryonal tumors were referred to as primitive neuroectodermal tumors (PNETs). Embryonal tumors are all treated in similar ways, but medulloblastomas tend to have a better outlook than other types.

Medulloblastomas: These tumors start in the cerebellum. They tend to grow quickly and are among the brain tumors most likely to spread to other parts of the brain, spinal cord, or spinal fluid. But they also tend to respond well to treatment.

Treating medulloblastoma often requires multiple types of treatment including surgery to remove the tumor and make sure the CSF can flow around the brain properly, radiation to the brain and spinal cord, and chemotherapy.

For children younger than 3, doctors try to use as little radiation as possible. In these cases, chemotherapy is typically the first treatment given after surgery. Depending on how the tumor responds, chemotherapy might be followed by radiation therapy.

Other ways of treating medulloblastoma, such as high-dose chemotherapy with a stem cell transplant and giving chemotherapy directly into the ventricles of the brain, are being studied in certain children, especially young children.

For more information, see Medulloblastoma.

Other embryonal tumors: For children under age 3, most doctors treat these tumors with chemotherapy and surgery, trying to avoid or delay radiation until the brain is more mature and the side effects may be less severe. Children older than age 3 are often offered treatment with combined surgery, chemotherapy, and radiation to the brain and spinal cord.

Benign choroid plexus papillomas are usually cured with surgery.

Choroid plexus carcinomas are malignant tumors that are only sometimes cured by surgery. After surgery, these carcinomas are treated with radiation therapy or chemotherapy, especially if the tumor was not completely removed or comes back after surgery.

These slow-growing tumors are usually benign and often do not need to be treated right away. Sometimes these tumors can be observed with imaging tests to determine whether they are growing or need treatment. If your cancer care team decides treatment is needed, they can often be cured with surgery. In some centers, small vestibular schwannomas (also known as acoustic neuromas) are treated with stereotactic radiosurgery. For larger schwannomas, where complete removal is likely to cause problems, the surgeon will remove as much of the tumor as safely possible, and what is left is treated with radiosurgery.

For people with neurofibromatosis type 2 (NF2) who have vestibular schwannomas, targeted therapy with bevacizumab can be an option.

There are different types of germ cell tumors. Each type may have a different treatment approach.

Germinomas, the most common type of germ cell tumor, can often be cured with radiation therapy alone after being diagnosed by surgery or by looking at a cerebrospinal fluid (CSF) sample. In some cases, chemotherapy may be an option, sometimes combined with radiation depending on the child’s age. Radiation can have more serious side effects in younger children.

Mature teratomas can usually be cured with surgery to remove the tumor.

Other non-germinoma germ cell tumors (NGGCT) often need combined treatment with chemotherapy and radiation to the brain and spinal cord, called craniospinal irradiation (CSI). Sometimes surgery can remove any tumor left after chemotherapy. This can help determine whether the tumor is responding well to treatment.

Germinomas and mature teratomas tend to have a better outlook than other germ cell tumors. Clinical trials for NGGCTs are adding high-dose chemotherapy and stem cell transplant for these tumors to see if better outcomes are possible with this approach.

Most pituitary adenomas are treated with surgery. An exception is prolactinomas (pituitary adenomas that make prolactin hormone). These tumors may be managed with medications such as cabergoline or bromocriptine, which block the tumor cells from making the prolactin hormone.

If a tumor cannot be managed with surgery or medications, sometimes radiation therapy may be used.

Craniopharyngiomas grow very close to important parts of the brain (the pituitary gland, the optic nerves, and blood vessels that supply the brain), so they can be hard to remove completely with surgery.

Some cancer centers still prefer surgery with the goal of removing as much of the tumor as possible, while others prefer to remove some of the tumor (debulking) and then give radiation therapy to lower the risk of damage to parts of the brain around the tumor during surgery. Partial tumor removal followed by very focused radiation therapy may cause fewer severe side effects than complete removal. However, it’s not yet clear if this approach is as good at preventing the tumor from growing back. Talk to your care team about the approach planned for your child or teen.

Pineoblastoma tumors are aggressive tumors of the pineal gland in the brain. They are treated like medulloblastomas and other high-risk embryonal tumors, with a combination of surgery and chemotherapy. Cranial and spinal radiation may also be used, depending on the child’s age. These tumors are hard to treat in younger children or when they have spread (metastasized).

Surgery is the main treatment for meningiomas that are growing or causing symptoms. Children and teens are usually cured if the surgery removes the tumor completely.

Some tumors, particularly those at the base of the brain, cannot be removed completely, and some are invasive and come back even though they were thought to be completely removed. External beam radiation therapy after surgery or stereotactic radiosurgery may be considered if the tumor biopsy shows a higher-grade tumor, full removal of the tumor is not possible at diagnosis, or the tumor comes back.

For meningiomas that are harder to treat and those that return after standard treatments, newer targeted treatments are being used. These drugs work by blocking blood vessel growth and include tyrosine kinase inhibitors such as sunitinib and immunotherapy drugs such as bevacizumab. More research is underway to find better treatments for meningiomas.

See Meningioma to learn more.