Treatment of Newly Diagnosed Childhood Brain and Spinal Cord Tumors
Childhood Brain Stem Glioma
Current Clinical Trials
Childhood Central Nervous System (CNS) Embryonal Tumors
Current Clinical Trials
Childhood CNS Germ Cell Tumors
Current Clinical Trials
Childhood Cerebellar Astrocytoma
Current Clinical Trials
Childhood Cerebral Astrocytoma
Current Clinical Trials
Childhood Craniopharyngioma
Current Clinical Trials
Childhood Ependymoma
Current Clinical Trials
Childhood Ependymoblastoma
Current Clinical Trials
Childhood Malignant Glioma
Current Clinical Trials
Childhood Medulloblastoma
Current Clinical Trials
Childhood Medulloepithelioma
Current Clinical Trials
Childhood Pineal Parenchymal Tumors
Current Clinical Trials
Childhood Spinal Cord Tumors
Current Clinical Trials
Childhood Supratentorial Primitive Neuroectodermal Tumors
Current Clinical Trials
Childhood Visual Pathway and Hypothalamic Glioma
Current Clinical Trials
Childhood Brain Stem Glioma
Childhood brain stem gliomas include:
- Diffuse intrinsic pontine gliomas.
- Focal or low–grade brain stem gliomas.
Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more
information
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood brain stem glioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Central Nervous System (CNS) Embryonal Tumors
Childhood CNS embryonal tumors include:
- Atypical teratoid/rhabdoid tumors.
- Ependymoblastomas.
- Medulloblastomas.
- Medulloepitheliomas.
- Pineal parenchymal tumors of intermediate differentiation.
- Pineoblastomas.
- Supratentorial primitive neuroectodermal tumors.
Refer to the PDQ summaries on Childhood Medulloblastoma Treatment and Childhood Central Nervous System Embryonal Tumors Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood embryonal tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood CNS Germ Cell Tumors
Childhood CNS germ cell tumors include:
- Germinomas.
- Embryonal yolk sac tumors.
- Choriocarcinomas.
- Immature teratomas.
- Mature teratomas.
- Teratomas with malignant transformation.
- Mixed germ cell tumors.
- Nongerminomatous germ cell tumors.
Surgery, other than biopsy to establish the diagnosis, rarely plays a role in the
treatment of CNS germinomas. The role of surgical
resection for nongerminomatous germ cell tumors and teratomas remains to be
defined.[1] For germinomas, irradiation with doses of 45 Gy to 54 Gy to the
tumor and 21 Gy to 36 Gy to the whole brain and spine is usually curative. In
selected cases, germinoma can be effectively treated with ventricular field radiation
therapy and at lower dose levels (30–36 Gy) following response to chemotherapy.[1] Although experience with
pre-irradiation chemotherapy has shown that most of these tumors
respond to cyclophosphamide and platinum-containing drugs, the definitive role
of chemotherapy has yet to be determined.[1] Disseminated germinomas are treated with craniospinal
irradiation,[2,3] alone or in combination with chemotherapy. The usual dose to the
tumor is 45 Gy to 54 Gy with 27 Gy to 36 Gy to the whole brain and spine. Although nongerminomatous germ cell tumors, such as
embryonal carcinomas, yolk cell tumors, and mixed germ cell tumors, may respond
to chemotherapeutic agents such as cisplatin or carboplatin, etoposide,
cyclophosphamide, and vinblastine, as do such histologies outside of the CNS,
optimal combination of agents, and the timing of chemotherapy in relation to radiation therapy
remains to be determined.[4-6] Information about ongoing clinical trials is
available from the NCI Web site.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood central nervous system germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Cerebellar Astrocytoma
Refer to the PDQ summary on Childhood Cerebellar Astrocytoma Treatment for
more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood cerebellar astrocytoma, childhood high-grade cerebellar astrocytoma, childhood low-grade cerebellar astrocytoma and untreated childhood cerebellar astrocytoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Cerebral Astrocytoma
Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more
information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood low-grade cerebral astrocytoma and childhood high-grade cerebral astrocytoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Craniopharyngioma
Therapies for craniopharyngioma include surgery and conventional external
radiation therapy, and in selected cases, stereotactic radiosurgery or
intracavitary irradiation. In general, each of these modalities, either alone
or in combination, can give a high rate of long-term disease control in the
majority of patients. Debate centers on the relative morbidity of the
different approaches.[7-13] Treatment of cystic tumors with intracavitary
chemotherapy has also been reported.[14]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood craniopharyngioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Ependymoma
Refer to the PDQ summary on Childhood Ependymoma Treatment for more
information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with newly diagnosed childhood ependymoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Ependymoblastoma
Refer to the PDQ summaryon Childhood Central Nervous System Embryonal Tumors Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood ependymoblastoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Malignant Glioma
Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood cerebral astrocytoma/malignant glioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Medulloblastoma
Refer to the PDQ summaries on Childhood Medulloblastoma Treatment and Childhood Central Nervous System Embryonal Tumors Treatment for more
information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with untreated childhood medulloblastoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Medulloepithelioma
Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood medulloepithelioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Pineal Parenchymal Tumors
Childhood pineal parenchymal tumors include:
- Pineoblastomas.
- Pineocytomas.
- Pineal parenchmal tumors of intermediate differentiation.
Refer to the PDQ summaries on Childhood Supratentorial Primitive Neuroectodermal
Tumors and Pineoblastoma Treatment and Childhood Central Nervous System Embryonal Tumors Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood pineal parenchymal tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Spinal Cord Tumors
The optimal treatment for intrinsic/intramedullary glial spinal cord tumors has
not been determined by prospective randomized trials. Therapeutic options
include surgery alone, surgery plus local radiation therapy, and possibly
adjuvant chemotherapy in selected cases.[15,16] Extensive surgical resections
are technically possible for many patients with intramedullary spinal cord
tumors, but may result in worsening neurologic status in at least 10%
of cases.[15,16] Surgery is usually indicated at least to determine the type of
tumor present; for low-grade glial tumors this may be the only treatment
required.[15] In one recent series of 164 children and young adults with
intramedullary low-grade glial tumors or ganglioglial spinal cord tumors, 70%
were controlled for 5 years after extensive surgical resections.[15] Radiation therapy has been demonstrated to control disease in some patients with
low-grade glial tumors after subtotal resections.[16-18] The role of
chemotherapy for spinal cord tumors is poorly characterized, but some very
young children with low-grade glial tumors have been successfully treated with
a carboplatin and vincristine drug regimen.[19] Outcomes for patients with
high-grade glial tumors have been extremely poor; most
develop progressive disease within 3 years of treatment with surgery,
radiation, and/or chemotherapy.[15,17,18]
The optimal treatment for children with spinal ependymomas has not been well characterized (refer to the PDQ summary on Childhood Ependymoma Treatment for more information). As is the case for glial tumors, treatment options
predominantly consist of either surgery alone or surgery followed by local
radiation therapy.[15,16] Management of primitive neuroectodermal tumors of the
spinal cord is also not well delineated, and most patients are treated on
treatment protocols designed for children with high-risk medulloblastoma.
(Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more information.) Also refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood spinal cord neoplasm. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Supratentorial Primitive Neuroectodermal Tumors
Childhood supratentorial primitive neuroectodermal tumors include:
- Primitive neuroectodermal tumors.
- Cerebral Neuroblastomas.
Refer to the PDQ summaries on Childhood Supratentorial Primitive Neuroectodermal
Tumors and Pineoblastoma Treatment and Childhood Central Nervous System Embryonal Tumors Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood supratentorial primitive neuroectodermal tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Childhood Visual Pathway and Hypothalamic Glioma
Refer to the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma
Treatment for more information.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood visual pathway and hypothalamic glioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
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Matsutani M, Sano K, Takakura K, et al.: Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86 (3): 446-55, 1997.
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Dearnaley DP, A'Hern RP, Whittaker S, et al.: Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962-1987. Int J Radiat Oncol Biol Phys 18 (4): 773-81, 1990.
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Linstadt D, Wara WM, Edwards MS, et al.: Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys 15 (2): 291-7, 1988.
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Balmaceda C, Heller G, Rosenblum M, et al.: Chemotherapy without irradiation--a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study. J Clin Oncol 14 (11): 2908-15, 1996.
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Bouffet E, Baranzelli MC, Patte C, et al.: Combined treatment modality for intracranial germinomas: results of a multicentre SFOP experience. Société Française d'Oncologie Pédiatrique. Br J Cancer 79 (7-8): 1199-204, 1999.
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Regine WF, Kramer S: Pediatric craniopharyngiomas: long term results of combined treatment with surgery and radiation. Int J Radiat Oncol Biol Phys 24 (4): 611-7, 1992.
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Hetelekidis S, Barnes PD, Tao ML, et al.: 20-year experience in childhood craniopharyngioma. Int J Radiat Oncol Biol Phys 27 (2): 189-95, 1993.
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Backlund EO, Axelsson B, Bergstrand CG, et al.: Treatment of craniopharyngiomas--the stereotactic approach in a ten to twenty-three years' perspective. I. Surgical, radiological and ophthalmological aspects. Acta Neurochir (Wien) 99 (1-2): 11-9, 1989.
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Pollock BE, Lunsford LD, Kondziolka D, et al.: Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results. Int J Radiat Oncol Biol Phys 33 (2): 437-46, 1995.
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Van Effenterre R, Boch AL: Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97 (1): 3-11, 2002.
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De Vile CJ, Grant DB, Kendall BE, et al.: Management of childhood craniopharyngioma: can the morbidity of radical surgery be predicted? J Neurosurg 85 (1): 73-81, 1996.
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Takahashi H, Nakazawa S, Shimura T: Evaluation of postoperative intratumoral injection of bleomycin for craniopharyngioma in children. J Neurosurg 62 (1): 120-7, 1985.
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Constantini S, Miller DC, Allen JC, et al.: Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93 (2 Suppl): 183-93, 2000.
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Bouffet E, Pierre-Kahn A, Marchal JC, et al.: Prognostic factors in pediatric spinal cord astrocytoma. Cancer 83 (11): 2391-9, 1998.
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Hardison HH, Packer RJ, Rorke LB, et al.: Outcome of children with primary intramedullary spinal cord tumors. Childs Nerv Syst 3 (2): 89-92, 1987.
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O'Sullivan C, Jenkin RD, Doherty MA, et al.: Spinal cord tumors in children: long-term results of combined surgical and radiation treatment. J Neurosurg 81 (4): 507-12, 1994.
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