At Boston Children's, we know how difficult a diagnosis of germ cell tumors can be, both for your child and for your whole family. That's why our physicians are focused on family-centered care: From your first visit, you'll work with a team of professionals who are committed to supporting all of your family's physical and psychosocial needs. We'll work with you to create a care plan that's best for your child.
What are the treatments for a germ cell tumors of the brain?
Treatment may include the following, alone or in combination.
Usually first step of treatment is surgery: a pediatric neurosurgeon removes as much of the tumor as possible while preserving your child's neurological function. Tumor specimens are examined by neuropathologists.
- Surgery is usually limited to well encapsulated teratomas, a particular tumor that includes all three cellular layers of germ cells, or in the case of blocked CSF flow.
- Complete resection or surgical removal of the entire tumor is ideal when possible. However, tumor location and other characteristics may limit removal to a partial or sub-total resection.
- A biopsy is the surgical removal of a sample of the tumor for diagnostic purposes. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured during removal.
Ventriculo-peritoneal shunt (VP shunt)
When a tumor causes blockage of cerebral spinal fluid (CSF) flow, special tubing can be surgically implanted in the ventricles to drain excess CSF into the abdomen. This bypasses the tumor blockage and relieves symptoms of hydrocephalus, the build up of fluid inside the skull.
Precisely targeted and dosed radiation is used to kill cancer cells left behind after surgery. This treatment is important to control the local growth of tumor.
- Tumors that are not likely to spread receive radiation only to the tumor and the area surrounding it.
- If we determine the tumor is more likely to spread beyond its original tumor location, radiation to other parts of the brain and spinal cord may be recommended.
- If the tumor has spread, radiation to the whole brain and spinal cord are used to treat certain germ cell tumors.
Chemotherapy is a drug that interferes with the cancer cell's ability to grow or reproduce. Chemotherapy before surgery may help shrink the tumor, making it possible to remove.
- Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
- Often, a combination of chemotherapy drugs is used.
- Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.
While chemotherapy can be quite effective in treating certain cancers, the agents don't differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells.
Chemotherapy can be given:
- as a pill to swallow.
- as an injection into the muscle or fat tissue.
- Intravenously, directly to the bloodstream (also called IV).
- Intrathecally, which means directly delivering the chemotherapy into the spinal column with a needle.
What is the expected prognosis after treatment for my child?
Outcomes vary widely, depending on the precise type of germ cell tumor your child has. In general, germinomas are cured in greater than 85 percent of cases with combined treatment.
- Mature teratomas are curable with complete resection alone.
- Immature teratomas usually require additional therapy.
- Other germ cell tumors, the mixed and malignant types, are more difficult to treat.
What is the recommended long-term care for my child?
Children treated for a germ cell tumor in the brain should visit a survivorship clinic every year to:
- manage disease complications
- screen for early recurrence of tumor
- manage late effects of treatment
A typical follow-up visit may include some or all of the following:
- a physical exam
- laboratory testing
- imaging scans
Through the Stop and Shop Family Pediatric Neuro-Oncology Outcomes Clinic as Dana-Farber Cancer Institute, children are able to meet with their neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit.
- Endocrinologists, neuro-psychologists, alternative/complementary therapy specialists, and school liaison and psychosocial personnel from the pediatric brain tumor team are also available.
- In addition, children needing rehabilitation may meet with speech, physical, and occupational therapists during and after treatments.