Cerebellar Low-Grade Astrocytoma

  • Having a pediatric brain tumor is always a very serious matter, and a cerebellar low-grade astrocytoma is no exception. Cerebellar low-grade astrocytomas are tumors that arise in the cerebellum, the part of the brain that controls balance and coordination. 

    Most children and adolescents diagnosed with brain tumors survive into adulthood. Many of them face physical, psychological, social and intellectual challenges related to their treatment. They require ongoing care to help with school and with the skills they will use throughout adulthood.

    Below, you’ll find detailed information about cerebellar low-grade astrocytomas. If you would like to read more general information about brain tumors, see our overview on pediatric brain tumors.

    How Dana-Farber/Boston Children’s assesses cerebellar low-grade astrocytomas

    Children with cerebellar low-grade astrocytomas receive comprehensive treatment through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, an integrated pediatric oncology program that provides—in one specialized program—all the services of both a leading pediatric cancer center and a pediatric hospital.

    After treatment, your child will receive expert follow-up care through the Stop & Shop Pediatric Family Neuro-Oncology Outcomes Clinic at Dana-Farber/Boston Children’s, where he will be able to meet with his neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit.

    Our pediatric brain tumor clinic is held weekly.   In addition to meeting with your pediatric neuro-oncologists, neurologist and neurosurgeon, your child also may need to see one of our endocrinologists or other subspecialists.   School liaisons and psychosocial personnel from the pediatric brain tumor team also are available to see your child.   If your child needs rehabilitation, they also may meet with speech, physical and occupational therapists during and after treatments.

    “The largest predictor of how a child will do in an operation is not based on where the tumor is or how big it is. The No. 1 predictor is how experienced the neurosurgeon is in doing that operation in children.”
    Mark Kieran, MD, PhD, director, Brain Tumor Center, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center

    Reviewed by Peter Manley, MD
    Boston Children’s Hospital, 2012

  • You may have a lot of questions when your child is diagnosed with a cerebellar low-grade astrocytoma:

    • What exactly is it?
    • What are potential complications in my child’s case?
    • What are the treatments?
    • What are possible side effects from treatment?
    • How will it affect my child in the long term?

    We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s condition and treatment options fully.

    What are cerebellar low-grade astrocytomas?

    These tumors are classified as gliomas, meaning that they arise in the brain's glial tissues—tissues made up of cells that help support and protect the brain's neurons (sometimes they are also called low-grade cerebellar gliomas). Because they are “low-grade” tumors, they're slow-growing and less aggressive than high-grade tumors. These have a higher chance of cure, too. 

    Brain tumors in children are relatively rare, occurring in only five of every 100,000 children. Low-grade cerebellar astrocytomas account for 10 to 20 percent of all childhood brain tumors. They tend to occur before a child is age 10 and are most common between the ages of 6 and 9.

    How are cerebellar low-grade astrocytomas classified?

    An important part of diagnosing a brain tumor involves staging and classifying the disease, which will help your child’s doctor determine treatment options and prognosis. Staging is the process of determining whether the tumor has spread and if so, how far.

    There are four “grades” of astrocytomas, according to how the cells look under a microscope. Ordered from least to most severe, they are:   

    Low Grade

    High Grade

    Cerebellar low-grade gliomas are either grade I or grade II. Of children with this type of tumor:

    • 80 to 85 percent have grade I tumors
    • 15 to 20 percent have grade II tumors

     What causes cerebellar low-grade astrocytomas?

    While research has shown a link between some types of low-grade astrocytomas (including cerebellar astrocytomas) and certain genetic diseases, specifically neurofibromatosis and tuberous sclerosis, most often these tumors have no known cause.


    What are the symptoms of cerebellar low-grade astrocytomas?

    Since cerebellar low-grade astrocytomas grow relatively slowly, your child may have symptoms for many months by the time they are diagnosed, or the symptoms may appear more suddenly.

    More than 90 percent of children with cerebellar low-grade astrocytomas have symptoms related to increased pressure in the brain, including:

    • headache (generally upon awakening in the morning)
    • nausea and vomiting (often worse in the morning and improving throughout the day)
    • fatigue

    Since the cerebellum affects balance and coordination, many children also show symptoms related to a lack of coordination (also called ataxia).

    Keep in mind that these symptoms may resemble other, more common conditions or medical problems. If you don’t have a diagnosis and are concerned, always consult your child's physician.

  • How are cerebellar low-grade astrocytomas diagnosed?

    Your child’s physician may order a number of different tests to best diagnose the tumor. In addition to a physical exam, a medical history and neurological exam (which tests reflexes, muscle strength, eye and mouth movement, coordination and alertness), your child’s doctor may request tests including:

    • computerized tomography scan (also called a CT or CAT scan)- a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images of the brain. CT scans are more detailed than general x-rays. If a low-grade astrocytoma is suspected, your child may have a CT scan of the brain.
    • magnetic resonance imaging (MRI)- a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of the brain and spine. For cerebellar low-grade astrocytomas, an MRI of the brain is usually performed
    • Resection or biopsy- in most cases, this tumor can be removed (resected) by a surgeon. At that time a tissue sample from the tumor is sent to our lab to determine the type of astrocytoma your child has. Occasionally, if a resection of the tumor is not possible, doctors will do a biopsy (remove a small amount of tumor) to confirm the diagnosis.

    After we complete all necessary tests, our experts will meet to review and discuss what they have learned about your child's condition, discuss the results and outline the best treatment options.

  • Children with cerebellar low-grade astrocytomas are treated through the Glioma Program at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children’s Hospital. Working together, we provide more specialists, more programs, and more clinical trials than almost any other pediatric center treating cancer and blood disorders in the world.

    Your child’s physician will determine a specific course of treatment based on several factors, including:

    • your child's age, overall health and medical history
    • type, location and size of the tumor
    • extent of the disease

    There are a number of treatments we may recommend. Some of them help to treat the tumor while others are intended to address complications of the disease or side effects of the treatment. These treatments include:


    Doctors treat many patients with low-grade astrocytomas with surgery. If the tumor is removed, the symptoms caused by increased pressure within the brain, such as headache, vomiting and lethargy, usually go away. A child’s coordination and balance improves as well. 

    If a tumor can be removed surgically, your child's doctors will carefully watch for regrowth or recurrence. If the tumor does recur, or if it re-grows after partial surgical removal, your child’s doctor may recommend a second attempt at surgical removal or de-bulking of the tumor.


    Chemotherapy is a drug treatment that works by interfering with tumor cells' ability to grow or reproduce. Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.

    Several combinations of chemotherapy drugs are used to treat cerebellar low-grade astrocytomas, including:

    • vincristine with carboplatin
    • vincristine with CCNU, procarbazine and thioguanine

    How is chemotherapy given?

    Your child may receive chemotherapy:

    • orally, as a pill to swallow
    • ntramuscularly (or "IM"), as an injection into the muscle or fat tissue
    • intravenously (or "IV"), directly to the bloodstream
    • intrathecally, with a needle directly into the spinal fluid

    Does chemotherapy cause side effects?

    While chemotherapy can be quite effective in treating certain cancers, the drugs cannot tell the difference between normal healthy cells and cancer cells. Because of this, your child may experience side effects during treatment. Knowing what these side effects are can help you, your child and your care team prepare for, and, in most cases, prevent or lessen these symptoms.

    What are common side effects and how are they managed?

    Common side effects to chemotherapy include fatigue, headache, constipation, nausea and vomiting. These side effects can usually be effectively managed with standard medical approaches.

    Our pediatric Brain Tumor Center also has access to specialists who deliver complementary or alternative medicines. These treatments, which may help control pain and side effects of therapy, include the following.

    • acupuncture/acupressure
    • therapeutic touch
    • massage
    • herbs
    • dietary recommendations

    Talk to your child’s physician about whether complementary or alternative medicine might be a viable option.


    Our doctors may use precisely targeted and dosed radiation to kill cancer cells left behind after your child’s surgery. This treatment is important for controlling the local growth of tumor.

    We usually don’t use radiation unless your child’s tumor does not respond to chemotherapy. Because of the potential long-term side effects of radiation, including effects on learning, hormone function and risk of second cancers, it is best avoided.

    What is the long-term outlook for a child with cerebellar low-grade astrocytoma?

    Grade I cerebellar astrocytomas have a 10-year survival rate of 90 to100 percent with surgical removal alone. Grade II cerebellar astrocytomas are more likely to reappear after they’ve been removed by surgery.

    What about progressive or recurrent disease?

    There are many standard and experimental treatment options for children with progressive or recurrent cerebellar low-grade astrocytomas. Dana-Farber/Boston Children’s has a robust research effort aimed at advancing the treatment of brain tumors and improving the lives of brain tumor survivors.

    Resources & support

    There are also a number of resources and support services at Dana-Farber/Children's Hospital Cancer Center to help you and your family through this difficult time.

    When appropriate, our Pediatric Advanced Care Team (PACT) offers supportive treatments intended to optimize the quality of life and promote healing and comfort for children with life-threatening illness.

    Long-term follow-up

    Today, the majority of children and adolescents diagnosed with pediatric brain tumors will survive into adulthood. However, many of them will face physical, psychological, social and intellectual challenges related to their treatment and will require ongoing assessment and specialized care.

    To address the needs of this growing community of brain tumor survivors, Dana-Farber/Children's Hospital Cancer Care established the Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic.

    Today, more than 1,000 pediatric brain tumor survivors of all ages are followed by the Outcomes Clinic, a multi-disciplinary program designed to address long-term health and social issues for families and survivors of childhood brain tumors. Some of the post-treatment services provided by the Outcomes Clinic include:

    • MRI scans to monitor for tumor recurrences
    • intellectual function evaluation
    • endocrine evaluation and treatment
    • neurologic assessment
    • psychosocial care
    • hearing, vision monitoring
    • motor function evaluation and physical therapy
    • complementary medicine

    As a result of treatment, children may experience changes in intellectual and motor function. Among several programs addressing these needs are the School Liaison and Back to School programs, which provide individualized services to ease children's return to school and maximize their ability to learn.

    In addition to providing thorough and compassionate care, our Outcomes Clinic specialists conduct innovative survivorship research and provide continuing education for patients and families.

  • Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is one of nine institutes in the nation belonging to the Pediatric Oncology Therapeutic Experimental Investigators Consortium (POETIC), a collaborative clinical research group dedicated to the development of new and innovative treatments for children with newly diagnosed as well as progressive or recurrent cerebellar astrocytomas and other brain tumors. The consortium offers experimental therapies to patients with relapsed (returning) or refractory (resistant to treatment) disease.

    Dana-Farber/Boston Children’s is also home to the Pediatric Low-Grade Astrocytoma (PLGA) Research Program, the world’s largest program dedicated to pediatric low-grade gliomas. The program conducts advanced research on the causes and treatment of low-grade gliomas.

    Through the PLGA program, and collaboration with the Broad Institute of Harvard and MIT, we have made strides toward a better understanding of these conditions and have pioneered strategies for analyzing the genetic and molecular characteristics of pediatric low-grade astrocytomas. We have established a patient registry and initiated multiple international research projects including phase II protocols using molecular inhibitors for children with progressive/recurrent low-grade gliomas. 

    Clinical trials

    For many children with rare or hard-to-treat conditions, clinical trials provide new options.

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