Children with glioblastoma multiforme or anaplastic 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.
There are a number of treatments we may recommend. Some of them help to treat the tumor, while others address complications of the disease or side effects of the treatment.
The primary treatment for newly-diagnosed GBM and AA includes:
Surgery for brain tumor removal
The first treatment is usually surgery to remove as much of the tumor as possible, ideally using advanced techniques, such as intraoperative MRI (where surgeons can visualize the tumor as they operate with MRI scans), to maximize tumor removal.
- Pediatric neurosurgery has multiple roles in the management of childhood glioblastoma multiforme and anaplastic astrocytoma, including treatment of increased intracranial pressure, biopsy and tumor removal.
- Complete resection or surgical removal of the entire tumor is ideal when possible, though most high-grade gliomas cannot be completely removed because they tend to infiltrate into adjacent healthy tissues.
- In general, the more completely the tumor can be removed, the greater the chances for survival.
Your child also may receive precisely targeted and dosed radiation to kill cancer cells left behind after surgery. This is important to control the local growth of tumor, and it helps increase survival in high-grade gliomas.
Chemotherapy refers to drugs that interfere with the cancer cells' ability to grow or reproduce. To date, no chemotherapy regimen has been demonstrated to increase survival rates in children with GBM or AA, though, 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, we use a combination of chemotherapy drugs.
- We may give certain chemotherapy drugs in a specific order.
- A variety of chemotherapy regimens have been tested in the treatment of newly diagnosed high-grade gliomas.
- Studies in adults have suggested that certain drugs can produce modest responses in high-grade gliomas, but they have less effect in children.
- Several treatment regimens have produced responses, none have improved survival. Nor has the use of high-intensity chemotherapy (which, because it destroys a patient's bone marrow) is used in conjunction with what is called an autologous stem cell transplant.
- New methods that specifically target or stimulate an immune response against newly diagnosed GBM and AA tumors are now being tested.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
- orally, as a pill to swallow
- intramuscularly (IM), as an injection into the muscle or fat tissue
- intravenously (IV), directly to the bloodstream
- intrathecally, with a needle directly into the fluid surrounding the spine
How are side effects of brain tumor treatment in children managed?
There can be many adverse side effects during the treatment of glioblastoma multiforme and anaplastic astrocytoma. Knowing what these side effects are can help you, your child and your care team prepare for, and, in some cases, prevent these symptoms from occurring.
- Radiation therapy often produces inflammation, which can temporarily worsen symptoms and dysfunction. To control this, inflammation steroids are sometimes necessary.
- Chemotherapy drugs cannot tell the difference between normal healthy cells and cancer cells. Some of chemotherapy agents are associated with fatigue, diarrhea, constipation and headache. These side effects can be effectively managed under most circumstances 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.
- therapeutic touch
Talk to your child's physician about whether complementary or alternative medicine might be a viable option.
What is the expected outcome after treatment for glioblastoma multiforme or anaplastic astrocytoma?
Unfortunately, the prognosis for GBM and AA tumors remains very poor. In general, more complete removal of tumors, when possible, results in a greater chance of survival. Your child’s physician will discuss treatment options with you, including experimental clinical trials, and supportive care.
What about progressive or recurrent disease?
Unfortunately, the prognosis for GBM and AA remains very poor. In general, more complete surgical removal of the tumor, when possible, results in greater chance of survival. In some instances, experimental clinical trials can be an option.
Resources and support
There are also a number of patient and family support services at Dana-Farber/Boston Children's 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. PACT also can provide psychosocial support and help arrange end-of-life care when necessary.