Getting the right treatment for children with brain tumors

By Sharon Doering-Domanus and Nicole Brudos Ferrara

While brain and spinal tumors are relatively rare, they are the second most common group of childhood cancers. "Our latest data shows that for every 100,000 births, about 6 children will develop a brain tumor," says Jonathan Schwartz, D.O., a Mayo Clinic pediatric neuro-oncologist.

Brain tumors in children are masses of abnormal cells that grow in a child's brain or in the tissue and structures near the brain. There are many types of pediatric brain tumors, both cancerous and noncancerous. Treatment depends on tumor type, the location of the tumor within the brain, whether the tumor has spread, and a child's age and overall health.

Fortunately, says Dr. Schwartz, thanks to advances in technology and new treatments, children and their families now have more options.

Here's what he and other Mayo Clinic pediatric brain cancer experts recommend families consider when seeking treatment for a child with a brain tumor:

Find a cancer center that can provide a specialized team approach to your child's treatment.

Treating pediatric brain cancer requires an experienced team of pediatric neuro-oncologists, neurosurgeons, neurologists, radiation oncologists, pathologists and endocrinologists. This team should regularly discuss your child's imaging results, diagnosis, treatment plan, progress and recovery — working together to achieve the best outcome.

For example, Mayo Clinic's Pediatric Brain Cancer team mobilizes quickly when a child's cancer needs immediate attention. "We offer next-day appointments, so if you have a child who's been recently diagnosed, you can call us and we can fit you in," says Dr. Schwartz. The team will do a full neurological assessment of your child. "Our group will meet, we'll look at the imaging, we'll look at the story," he says.

In most pediatric brain tumor cases, surgery is the first step. "Surgery alone can be curative," says David Daniels, M.D., Ph.D., a Mayo Clinic pediatric neurosurgeon.

In other cases, tumors can't be separated from surrounding tissue or they're located near sensitive areas in the brain, making surgery risky. In these cases, the pediatric neurosurgeon removes as much of the tumor as possible.

"Sometimes we can only get a little piece of these tumors because if you were to be more aggressive, it would knock out some of the critical functions of the brain," says Dr. Schwartz. "Having a specialized group of neurosurgeons with expertise like Dr. Daniels allows us to do this safely, so we can get a diagnosis, get to treatment and not injure the child."

If the tumor can be removed or biopsied, a neuropathologist then examines the tumor tissue and helps the team understand precisely what type of cancer they are dealing with.

"From that point, our group again meets to formulate a plan," says Dr. Schwartz.

At Mayo Clinic members of a child's care team work together to develop a treatment plan personalized to the child's specific tumor type and needs. The plan may include chemotherapy drugs; targeted drug therapies that work based on tumor type; and rehabilitation services, such as physical therapy, occupational therapy, speech therapy and tutoring. Everyone is working together for the best big-picture outcome for the child.

"We want to maximize them getting back to life as they knew it prior to coming and meeting us," says Dr. Schwartz.

"Having a team like this that works together is really best, and that's what we hear from families all the time," says Dr. Daniels.

Proton beam therapy may protect your child's healthy tissue.

Surgery for pediatric brain tumors is often followed by another treatment, such as chemotherapy or radiation, to kill any remaining cancer cells. Mayo Clinic experts recommend seeking a cancer center that offers proton beam therapy in addition to traditional radiation treatment.

Proton beam therapy delivers higher targeted doses of radiation to brain tumors, minimizing radiation exposure to nearby healthy tissue. This appears to reduce short-term and long-term side effects and the chance of developing new cancers.

"Proton beam can deliver its energy at a precise point. And, so, in theory, you're targeting the brain tumor and leaving the normal brain alone," says Dr. Daniels.

Research on the long-term effectiveness of proton therapy is underway at Mayo Clinic.

Experts at Mayo Clinic believe proton beam therapy can be especially beneficial for children with certain types of brain tumors because a child's brain is still developing and is sensitive to the effects of even low and medium doses of radiation.

"It's safer, kinder and gentler to the surrounding brain," says Dr. Daniels.

Dr. Schwartz explains that proton beam can be particularly beneficial when radiation is needed across extensive areas of a child's body.

"Sometimes with medulloblastoma, an aggressive malignant brain tumor, we have to radiate the whole spine. In other forms of radiation, there can be scatter. Some of that radiation energy goes into the lungs, the heart, the liver and the diaphragm. When using proton beam, that extra energy doesn't go to those areas. And we minimize the toxicity, which I think is really important, especially for the youngest of children," he says.

Childhood cancer survivors may be at risk of late side effects of cancer treatment. Mayo Clinic pediatric brain tumor experts believe the use of proton beam therapy may minimize these late side effects, which vary depending on the child's type of cancer and the treatment they receive.

Clinical trials offer hope for kids with recurring or infiltrative brain tumors.

When looking for a team to provide brain tumor care for your child, it's important to ask about the availability of clinical trials, which are studies of new treatments. While more common forms of childhood brain tumors such as astrocytomas generally have excellent outcomes, some tumors don't respond to initial treatment or are more difficult cases that recur or infiltrate surrounding brain tissue. In these cases, clinical trials can offer additional treatment options.

"Recurrent tumors are a really difficult thing in pediatric neuro-oncology," says Soumen Khatua, M.B.B.S., M.D., a Mayo Clinic pediatric neuro-oncologist.

Dr. Khatua is particularly excited about immunotherapy clinical trials being conducted or planned at Mayo Clinic and other cancer centers.

Immunotherapy is treatment that uses a person's immune system to fight cancer. These are three common types of immunotherapy:

• Viral immunotherapy
  This treatment involves using the body's immune system to implant a virus into cancer cells to kill them.
• Cellular immunotherapy
  This treatment involves taking immune cells from a person's blood or tissue, growing them in large numbers in the laboratory, and then infusing them back into the person's body to help the immune system fight cancer. Sometimes the cells are modified in the laboratory to make them better able to target a person's cancer cells and kill them.
• Radioimmunotherapy
  This treatment involves linking a radioactive substance to a monoclonal antibody and injecting it into the body, where the monoclonal antibody binds to substances in the body, including cancer cells. As the radioactive substance gives off radiation, it kills cancer cells.

"I think these immunotherapies will really provide a platform of various novel trials for families across the country looking for options," says Dr. Khatua.

Learn more

Learn more about pediatric brain tumors and find a pediatric brain tumor clinical trial at Mayo Clinic.

Listen to Drs. Schwartz, Daniels and Khatua discuss the symptoms, diagnosis and treatment of pediatric brain tumors on this "Mayo Clinic Q&A" podcast.