Treatment

The treatment of a CNS tumor depends on the type of CNS tumor, the size and location of the tumor, whether it is cancerous, whether the cancer has spread, and the age of the child. Radiation therapy is often limited in children younger than three years old, because extensive radiation therapy can cause learning and memory problems later on in the child’s life.

Descriptions of the most common treatment options for a CNS tumor are listed below.

Surgery

Surgery is almost always used to determine the type of tumor, either through a biopsy or during treatment when the tumor can be removed without significant damage to the brain. A neurosurgeon is a doctor who specializes in treating a tumor in the brain or spine with surgery. The goal of brain tumor treatment is complete surgical removal of the tumor. Sometimes, a tumor spreads and grows between normal nerve cells, making surgery difficult. In certain cases, surgery can damage parts of the brain near the tumor, affecting arm and leg movement, breathing, swallowing, eye movement, or consciousness. Some tumors cannot be removed by surgery because of their location; these tumors are called inoperable; in these cases, the doctor will recommend other treatment options. Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

Stereotactic radiosurgery is a way to deliver high doses of radiation therapy directly to a tumor and not to healthy tissue. This technique produces detailed, three-dimensional maps of the brain and tumor, so doctors can pinpoint where to deliver the radiation treatment. It works best for certain noncancerous tumors and a tumor that is only in one area of the brain. Learn more about radiation therapy.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, headaches, and loose bowel movements. Most side effects go away soon after treatment is finished. However, in the long term radiation therapy can sometimes interfere with the normal growth and development of the child’s brain, so the doctor may choose to treat the tumor in another way.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time.

Chemotherapy is effective for many cancerous types of brain tumors. Depending on the tumor type, chemotherapy may be given immediately after a biopsy or surgery or following radiation therapy. In some instances, chemotherapy is used at the same time as radiation therapy.

Chemotherapy may also be given directly into the spinal canal, in a procedure called intrathecal chemotherapy, to treat cancer cells on the surface of the brain and spine. This procedure is still being investigated in clinical trials and may not be widely available.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications. Learn more about your child’s prescriptions by using searchable drug databases.

Stem cell transplantation/bone marrow transplantation

A stem cell transplantation/bone marrow transplantation may be used if a CNS tumor recurs. A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because blood stems cells are typically what is being transplanted, not the actual bone marrow tissue.

There are two types of stem cell transplantation depending on the source of the replacement blood stem cell: allogeneic (ALLO) and autologous (AUTO). AUTO transplantations are used to treat a CNS tumor.

In an AUTO transplant, the patient’s own stem cells are used as the replacement cells, instead of cells from a donor. The stem cells are obtained from the patient when he or she is in remission from previous treatment. The stem cells are frozen until they are needed, usually after the high-dose treatment (explained below) is completed.

The goal of transplantation is to destroy cancer cells in the marrow, blood, and other parts of the body and have replacement blood stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts.

Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health.

In stem cell transplantation, replacement cells engraft (begin to make new blood cells) and turn into healthy, blood-producing tissue in 10 days to three weeks. Destroying the patient’s own marrow reduces the body’s natural defenses, temporarily leaving the patient at an increased risk of infection. Until the patient’s immune system is back to normal, patients may need antibiotics and blood transfusions.

In an AUTO transplant, there is little risk of tissue rejection because the replacement stem cells are the patient’s own cells. However, there is a risk in an autologous transplant that some of the cells that are put back into the patient could still be cancerous. Learn more about bone marrow and stem cell transplantation.

Recurrent CNS tumor

If a CNS tumor comes back after initial treatment, the next phase of treatment depends on three factors:

• The type of tumor
  
  
• Whether the tumor recurred where it originally began or in another part of the brain or body
  
  
• The type of treatment the child received for the original tumor

Depending on individual circumstances, the doctor may recommend surgery, radiation therapy, chemotherapy, and/or stem cell transplantation.

Find out more about common terms used during treatment.