Health Library Brain Cancer, Cerebral Astrocytoma, Childhood: Treatment - Patient Information [NCI PDQ]From Healthwise

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Childhood Cerebral Astrocytoma/Malignant Glioma Treatment (PDQ®)

Cerebral astrocytoma is a type of malignant glioma.

Childhood cerebral astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.

Astrocytomas are tumors that start in brain cells called astrocytes. Cerebral astrocytomas form in the area of the brain called the cerebrum. The cerebrum, which is at the top of the head, is the largest part of the brain. The cerebrum controls thinking, learning, problem-solving, speech, emotions, reading, writing, and voluntary movement.

Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)

The cause of most childhood brain tumors is unknown.

The symptoms of childhood cerebral astrocytoma vary and often depend on the child’s age, where the tumor is located, and the size of the tumor.

These symptoms may be caused by an astrocytoma or other conditions. A doctor should be consulted if any of the following problems occur:

• Weakness or change in feeling on one side of the body.
• Seizures.
• Morning headache or headache that goes away after vomiting.
• Nausea and vomiting.
• Unusual sleepiness or change in energy level.
• Change in personality or behavior.

Tests that examine the brain are used to detect (find) childhood cerebral astrocytoma.

The following tests and procedures may be used:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood cerebral astrocytoma is diagnosed and may be removed in surgery.

If a brain tumor is suspected, a brain biopsy is done by removing part of the skull and using a needle to remove a sample of the tumor tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

• Cancer cells remaining after surgery.
• The type of astrocytoma.
• The location of the tumor.

Treatment options depend on:

• Whether cancer cells remain after surgery.
• The location of the tumor.
• The child’s age.
• Whether the cancer has just been diagnosed or has recurred (come back).

After childhood cerebral astrocytoma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood cerebral astrocytoma, the grade of the tumor is used instead of stages. The grade of the tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment.

The following grades are used for childhood cerebral astrocytoma:

• Low grade cerebral astrocytoma: Tumors that are very slow-growing and rarely spread.
• High grade or malignant cerebral astrocytoma: Tumors that are fast-growing and may spread throughout the brain.

The following procedure may be used to determine if any cancer cells remained in the brain after surgery:

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Cerebral astrocytomas may form at more than one place in the brain and do not usually spread to other parts of the body.

Recurrent childhood cerebral astrocytoma is a tumor that has recurred (come back) after it has been treated. The tumor may recur many years after the first tumor. High grade cerebral astrocytoma, however, usually recurs within 3 years after it is first diagnosed. A recurrent tumor may come back in the brain or in other parts of the central nervous system.

There are different types of treatment for children with cerebral astrocytoma.

Different types of treatment are available for children with cerebral astrocytoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with cerebral astrocytoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

• Neurosurgeon.
• Neurologist.
• Neuropathologist.
• Neuroradiologist.
• Rehabilitation specialist.
• Radiation oncologist.
• Medical oncologist.
• Endocrinologist.
• Psychologist.

Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.

Three types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood cerebral astrocytoma as discussed in the General Information section of this summary. For patients with slow-growing tumors who are having seizures, MRI-guided surgery may be used to control both seizures and tumor growth.

Radiation therapy

Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Radiation therapy may be used in addition to chemotherapy.

Because radiation therapy can affect growth and brain development in young children, it is often used only when the cancer has started to spread. Newer ways of giving radiation are being studied that may have fewer side effects than standard methods. Conformal radiation therapy uses a computer to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing as much normal tissue as possible.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.

New types of treatment are being tested in clinical trials.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Low-Grade Childhood Cerebral Astrocytoma

Initial treatment for low grade cerebral astrocytoma depends on the location of the tumor. When the tumor is completely removed by surgery, more treatment may not be needed. The child is then closely observed for symptoms to appear or change. This is called watchful waiting. When the tumor is located deep inside the brain, surgery may not be possible. Biopsy followed by chemotherapy or radiation therapy may be used instead.

When cancer cells remain after surgery, treatment depends on the location of the remaining cancer cells and the age of the child. Treatment may include the following:

• Watchful waiting.
• Another surgery to remove the tumor.
• Radiation therapy.
• Chemotherapy.

One of the treatments being studied in clinical trials for low grade childhood cerebral astrocytoma is combination chemotherapy.

Information about this and other ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood low-grade cerebral astrocytoma.

High-Grade Childhood Cerebral Astrocytoma

Standard treatment of high grade childhood cerebral astrocytoma may include surgery followed by chemotherapy and radiation therapy.

Some of the treatments being studied in clinical trials for high grade childhood cerebral astrocytoma include the following:

• A clinical trial of surgery followed by chemotherapy to delay or reduce the use of radiation therapy for children younger than 3 years of age.
• A clinical trial of surgery followed by chemotherapy with or without radiation therapy.
• A clinical trial of surgery followed by chemotherapy during and after radiation therapy.

Information about these and other ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood high-grade cerebral astrocytoma.

Recurrent Childhood Cerebral Astrocytoma

Standard treatment of recurrent low grade childhood cerebral astrocytoma may include the following:

• Combination chemotherapy.
• Surgery followed by radiation therapy.
• Surgery followed by radiation therapy and chemotherapy.

Some of the treatments being studied in clinical trials for recurrent low grade childhood cerebral astrocytoma include new ways of giving radiation.

Standard treatment of recurrent high grade childhood cerebral astrocytoma may include biopsy or surgery.

Some of the treatments being studied in clinical trials for recurrent high grade childhood cerebral astrocytoma include the following:

• A clinical trial of high-dose chemotherapy with stem cell transplant.
• A clinical trial of a new therapy.

Information about these and other ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood cerebral astrocytoma.

CALL 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

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SEARCH THE NCI WEB SITE

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

FIND PUBLICATIONS

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

PDQ IS A COMPREHENSIVE CANCER DATABASE AVAILABLE ON NCI'S WEB SITE.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ CONTAINS CANCER INFORMATION SUMMARIES.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

THE PDQ CANCER INFORMATION SUMMARIES ARE DEVELOPED BY CANCER EXPERTS AND REVIEWED REGULARLY.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ ALSO CONTAINS INFORMATION ON CLINICAL TRIALS.

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

THE PDQ DATABASE CONTAINS LISTINGS OF GROUPS SPECIALIZING IN CLINICAL TRIALS.

The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

THE PDQ DATABASE CONTAINS LISTINGS OF CANCER HEALTH PROFESSIONALS AND HOSPITALS WITH CANCER PROGRAMS.

Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Date Last Modified: 2006-02-21

If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.

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