Removing the tumor
Usually the first step is removing as much of the tumor as possible without jeopardizing critical brain functions. In addition to state-of-the-art operating suites, neurosurgeons at Children's Hospital Boston have several tools to help them accomplish the most precise tumor removal possible, such as an intraoperative MRI, intraoperative laser and ultrasound, endoscopy, microscopes and navigations systems and stereotactic radiosurgery.

An intraoperative MRI is preformed in an operating room built around a magnetic resonance imaging machine, so that neurosurgeons can obtain real time images of complex tumors in the midst of surgery. The first equipment of this particular design in a pediatric hospital in the United States, this operating room will let surgeons remove brain tumors with utmost accuracy.

Stereotactic radiosurgery is not surgery as traditionally defined. It destroys small tumors by focusing several arcs of radiation so they intersect at the exact location of the tumor. Using this approach, the tumor receives a destructive dose of radiation, while the surrounding healthy tissues receive minimal exposure. Stereotactic radiosurgery may also be called Gamma-knife or X-knife radiosurgery.

Radiation Therapy
The radiation oncologists at Dana-Farber Cancer Institute and Children's Hospital Boston employ state-of-the-art radiation techniques to deliver tumor-killing doses of radiation to the necessary sites while minimizing damage to normal brain and spinal cord tissue. Some of these techniques include 3-dimensional conformal radiation planning, Intensity Modulated Radiation Therapy or IMRT, stereotactic radiation therapy, proton beam therapy and the use of radiation sensitizers.

Despite the advances in radiation techniques and our continued move towards lower and lower doses of radiation to the brain and spine, radiation therapy may also stop the growth of neural connections essential for learning and development. Our team makes every effort to minimize the use of radiation in young children because of the potential for long-term neurological and cognitive/intellectual damage.

Chemotherapy
Traditional chemotherapy refers to a group of medicines used to destroy cancerous cells by targeting rapidly multiplying cells. These agents have often been administered intravenously (IV) in the hospital. However, many of these drugs no longer require a hospital admission because they can now be given orally (by mouth) or administered in the outpatient clinic. Modern techniques now also allow the neuro-oncologists at Dana-Farber and Children's to administer chemotherapy directly into the tumor sites either in the brain or spinal fluid.

In addition to traditional chemotherapy, our neuro-oncologists use a variety of new agents to kill tumor cells. One of the most common alternative approaches targets the blood vessels supplying the tumor with the nutrients it needs to grow. This tumor-killing strategy, pioneered by doctors at Children's, is known as anti-angiogenic chemotherapy. Other agents called small molecule inhibitors are thought to act as "smart-bombs." They turn off signals the tumor needs to grow without causing as many side effects as other chemotherapy agents.

Note that the responses below make reference to the case highlighted in our MR/OR Webcast on October 25, 2007.