Thalamic Astrocytoma and Hypothalamic Astrocytoma

  • A brain tumor is always a very serious matter, and a thalamic or hypothalamic astrocytoma is no exception. A thalamic/hypothalamic astrocytoma is a low-grade, slow-growing glioma (brain tumor) that arises in either the thalamus, the hypothalamus or both.

    In the next tabs, you’ll find more detailed information about thalamic/hypothalamic astrocytomas. To read more general information about brain tumors first, see our overview on brain tumors.

    How Dana-Farber/Boston Children’s Cancer and Blood Disorders Center approaches thalamic/hypothalamic astrocytomas

    If your child is cared for at Boston Children’s, she will be seen at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center through our Glioma Program. Continue reading to learn more about thalamic or hypothalamic astrocystomas or visit the Glioma Program homepage to learn about our expertise and treatment options for this condition.

    After treatment, your child will receive expert follow-up care through our childhood brain tumor survivorship program within the Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic, where she can meet with her neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit.

    The largest predictor of how a child will do in an operation is not based on where the tumor is located 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 of the Pediatric Brain Tumor Program

    Reviewed by Susan Chi, MD
    Boston Children’s Hospital, 2013

  • What is a thalamic or hypothalamic astrocytoma?

    These pediatric brain tumors (also called gilomas) arise in the thalamus and the hypothalamus. The thalamus is a deep-lying central part of the brain responsible for identification of sensation, such as temperature, pain and touch; it is also the relay center for movement. The hypothalamus is the area just below the thalamus, responsible for hormone functioning, body temperature, sleep and appetite. Sometimes an astrocytoma can invade both areas—sometimes only one. “Low-grade” tumors are slow-growing and less aggressive than high-grade (malignant) tumors.

    How are thalamic/hypothalamic 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. Ordered from least to most aggressive, they are:

    • Low-grade gliomas
      • grade I (pilocytic)
      • grade II (fibrillary)
    • High-grade glioma
      • grade III (anaplastic)
      • grade IV (glioblastoma multiforme)

    Thalamic/hypothalamic astrocytomas are usually classified as grade I or grade II tumors.

    What causes thalamic/hypothalamic astrocytomas?

    While research has shown that there is a link between some types of low-grade astrocytomas (including thalamic/hypothalamic astrocytomas) and certain genetic diseases, specifically neurofibromatosis I and tuberous sclerosis, these tumors most often have no known cause. There’s nothing that you could have done or avoided doing that would have prevented these tumors from developing.

    What are the symptoms of thalamic/hypothalamic astrocytomas?

    Since thalamic/hypothalamic astrocytomas grow relatively slowly, your child may have been having symptoms for many months by the time she is diagnosed, or symptoms may appear more suddenly.

    Many children with thalamic/hypothalamic astrocytomas have symptoms related to increased pressure in the brain, including:

    • headache (generally upon waking in the morning)
    • nausea and vomiting (often worse in the morning and improving throughout the day)
    • fatigue
    • weakness on one side of the body

    Other symptoms your child may show include:

    • symptoms of hormone imbalance (weight loss/gain, symptoms of salt and water imbalance in the body such as retaining water or swelling or frequent urination)
    • changes in vision (since the thalamus and hypothalamus are found close to the nerves that carry visual signals with the brain)

    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.

  • The first step in treating your child’s astrocytoma is forming an accurate and complete diagnosis. Your child’s physician may order a number of different tests to best diagnose the tumor, in order to see exactly where it is and whether or how far it has spread. 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:

    • 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.
    • biopsy: In many cases, a tissue sample from the tumor will be taken through a needle during a simple surgical procedure to confirm the diagnosis.

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

  • Children with thalamic/hypothalamic 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. The Pediatric Glioma Program at Dana-Farber/Boston Children’s a world-renowned destination for children with low-grade and high-grade gliomas.

    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.

    Your child’s physician will determine a specific course of astrocytoma 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
    • your child's tolerance for specific medications, procedures or therapies
    • how your child's doctors expect the disease to progress

    There are a number of treatments we may recommend for astrocytoma. 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:

    Surgery for astrocytoma

    The surgeons will try to get as much of the tumor out as possible, since aggressive tumor removal is associated with better long-term outcomes. Surgery often is limited due to the deep, central placement of both the thalamus and hypothalamus within the brain. In addition, removal of the whole tumor can result in damage to critical brain areas.

    If the tumor recurs after initial surgical removal, or if the tumor re-grows after partial surgical removal, your child’s doctor may recommend a second attempt at removing as much of the tumor as possible.

    Chemotherapy for astrocytoma

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

    A number of combinations of chemotherapy drugs are being used to stabilize and, in some cases, to shrink the size of the tumor. These include:

    • vincristine with carboplatin
    • vincristine with CCNU, procarbazine and thioguanine
    • other chemotherapy combinations

    How is chemotherapy given?

    Your child may receive chemotherapy:

    • orally, as a pill to swallow
    • intravenously (IV), directly to the bloodstream

    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 adverse side effects during treatment. Knowing what these side effects are can help you and your child prepare for, and, in some cases, prevent these symptoms from occurring.

    What are common side effects and how are side effects managed?

    Common side effects to chemotherapy given for treatment of thalamic/hypothalamic astrocytomas include fatigue, headache, diarrhea and constipation. 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 the 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.

    Radiation Therapy

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

    We usually don’t use radiation therapy unless your child’s tumor has regrown after chemotherapy. Due to the potential long-term side effects of radiation therapy, including effects on learning and hormone function, it is best avoided if your child is younger (especially under age 10-years-old).

    What is the long-term outlook for thalamic/hypothalamic astrocytoma?

    Fortunately, children with astrocytomas of the thalamus and/or hypothalamus have a high rate of survival. The survival rate is not as high if the tumor can’t be removed completely during surgery or if it returns.

    There are many standard and experimental treatment options for children with progressive or recurrent low-grade astrocytomas, including thalamic/hypothalamic astrocytomas.

    Resources & support

    There are also a number of resources and support services at Dana-Farber/Boston Children's Cancer and Blood Disorders 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. PACT also can provide psychosocial support and help arrange end-of-life care when necessary.

    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/Boston Children's Cancer and Blood Disorders Center established a childhood brain tumor survivorship program through the Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic.

    More than 1,000 pediatric brain tumor survivors of all ages are followed by the Outcomes Clinic, a multidisciplinary 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 and vision monitoring
    • ovarian dysfunction evaluation and treatment
    • 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 staff, patients and families.

    To learn more about our services; to talk to us or schedule an appointment, please call us at 617-632-2680.

  • Dana-Farber/Boston Children's Cancer and Blood Disorders Center is one of nine institutions 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 all types of cancer and tumors. The consortium offers experimental therapies to patients with newly diagnosed tumors and 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 like thalamic/hypothalamic astrocytomas. The program conducts advanced research on the causes and treatment of low-grade gliomas.

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

    Clinical trials

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

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