Childhood Cerebral Astrocytoma/Malignant Glioma Treatment (PDQ®)

General Information About Childhood Cerebral Astrocytoma

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. See the following PDQ treatment summaries for more information:

• Childhood Brain and Spinal Cord Tumors Treatment Overview

• Adult Brain Tumors

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.

The following symptoms and others may be caused by an astrocytoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of these 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) with gadolinium: 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 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 sometimes 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) and treatment options depend on:

• Whether cancer cells remain after surgery.

• The type of astrocytoma.

• The grade of the tumor.

• Where the tumor is in the brain.

• The child’s age.

• Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Childhood Cerebral Astrocytoma

The grade of the tumor is used in place of a staging system to plan cancer treatment.

Staging is the process used to find out how much cancer there is and if cancer has spread. It is important to know the stage in order to plan treatment.

There is no standard staging system for childhood cerebralastrocytoma. Instead, the grade of the tumor is used to plan treatment. The grade of the tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread.

The following grades are used:

• Low-grade cerebral astrocytoma is a tumor that is very slow-growing and rarely spreads.

• High-grade or malignant cerebral astrocytoma is a tumor that is fast-growing and may spread throughout the brain.

Childhood cerebral astrocytoma may form in more than one place in the brain and usually does not spread to other parts of the body.

The information from tests and procedures done to detect (find) childhood cerebral astrocytoma is used to plan cancer treatment.

Some of the tests used to detect childhood cerebral astrocytoma are repeated after the tumor is removed. (See the General Information section.) This is to find out how much tumor remains after surgery and plan further treatment.

Recurrent Childhood Cerebral Astrocytoma

Recurrent childhood cerebralastrocytoma 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.

Treatment Option Overview

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

Different types of treatment are available for children with cerebralastrocytoma. 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. Some clinical trials are open only to patients who have not started treatment.

Children with cerebral astrocytoma should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.

Treatment will be overseen by a pediatriconcologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts 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.

Childhood brain and spinal cord tumors may cause symptoms that begin before diagnosis and continue for months or years.

Childhood brain and spinal cordtumors may cause symptoms that continue for months or years. Symptoms caused by the tumor may begin before diagnosis. Symptoms caused by treatment may begin during or right after treatment.

Some cancer treatments cause side effects months or years after treatment has ended.

These are called late effects. Late effects of cancer treatment may include the following:

• Physical problems.

• Changes in mood, feelings, thinking, learning, or memory.

• 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 effects cancer treatment can have on your child. (See 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 or keep them from growing. 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 them 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.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

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.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options for Childhood Cerebral Astrocytoma

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Low-Grade Childhood Cerebral Astrocytoma

Initial treatment for low-gradecerebralastrocytoma 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 cancercells 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.

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. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

High-Grade Childhood Cerebral Astrocytoma

Standard treatment of high-grade childhood cerebralastrocytoma 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.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood high-grade cerebral astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Recurrent Childhood Cerebral Astrocytoma

Standard treatment of recurrentlow-grade childhood cerebralastrocytoma 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.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood cerebral astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Childhood Brain Tumors

For more information from the National Cancer Institute about childhood brain tumors, see the following:

• What You Need to Know About™ Brain Tumors

• Pediatric Brain Tumor Consortium (PBTC)

For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer - An Overview

• Childhood Cancers

• CureSearch - National Childhood Cancer Foundation Children’s Oncology Group

• Late Effects of Treatment for Childhood Cancer

• Young People with Cancer: A Handbook for Parents

• Care for Children and Adolescents with Cancer: Questions and Answers

• Understanding Cancer Series: Cancer

• Staging: Questions and Answers

• Coping with Cancer

• Support and Resources

• Cancer Library

• Information for Survivors/Caregivers/Advocates

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Changes to This Summary (07/03/2008)

The PDQcancer 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.

Several enhancements have been made to this summary to better explain certain medical concepts and to help readers find information about clinical trials. The following changes were made:

• Information about patients taking part in clinical trials and about follow-up tests was added to the Treatment Option Overview section.

• Links to ongoing clinical trials listed in NCI's PDQ Cancer Clinical Trials Registry were added to the Treatment Options section.

• A new section called "To Learn More" was added. It includes links to more information about this type of cancer and about cancer in general.

• The "Get More Information from NCI" section (originally called "To Learn More") was revised.

About PDQ

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).

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).