Pediatric Low-grade Gliomas

A pediatric glioma is a kind of brain tumor that starts in the glial cells that support and nourish neurons in a child’s brain. Gliomas are divided into four grades, depending on the tumor cells’ appearance under a microscope — the higher a tumor’s grade number, the more aggressive it is.

Grades 1 and 2 are considered low-grade gliomas. These gliomas tend to be easily treatable and highly curable.

As a glioma grows, it presses on surrounding healthy parts of the brain, affecting their function. As such, the symptoms of a pediatric glioma depend heavily on the tumor’s size and where in the brain it is located. Some of the most common symptoms of a pediatric low-grade glioma include:

• Headache
• Severe or frequent vomiting
• Vision problems such as double vision, blurry vision, or loss of vision
• Difficulty walking or balancing
• Seizures
• Weight gain or loss
• Premature puberty
• Clumsiness
• Confusion or memory loss
• Sleepiness

To diagnose a pediatric glioma, your child’s doctor will take a medical history and perform physical and neurological exams. They may also order a variety of tests, including:

• Magnetic resonance imaging (MRI)
• Biopsy or tissue sample
• Electroencephalogram (EEG)
• Lumbar puncture

If your child undergoes surgical resection of the tumor or a biopsy, their doctor will be able to determine whether the tumor is a low-grade glioma or a high-grade glioma. A type of doctor called a pathologist will confirm the diagnosis by examining the tumor sample closely under a microscope and by doing molecular tests.

Our treatment approach for pediatric gliomas is personalized for each patient depending on several factors, including the tumor's type, stage, location, and molecular profile, as well as the patient’s age. Some therapies will treat the tumor, while others are intended to address complications of the disease or side effects of the treatment.

• Surgery. Surgical resection of low-grade gliomas is often curative. The decision to operate is based on several factors, including the size, location, and stage of the tumor.
• Surveillance imaging. Some families may choose to take a “watchful waiting” approach to care, particularly if the tumor is small and isn’t causing side effects. In this case, your child should undergo imaging scans every three to six months to ensure that the glioma hasn’t grown. If your child undergoes partial or total surgical resection of the tumor, they will also need to undergo surveillance imaging every three months, depending on their individual case.
• Chemotherapy. In some cases, your child’s doctor may recommend oral chemotherapy to target specific genetic mutations in the tumor. We offer both conventional chemotherapy and targeted inhibitors, some of which were developed by doctors and researchers in the Brain Tumor Center.

We treat children and teens with gliomas in the Glioma Program, part of the Brain Tumor Center at Dana-Farber/Boston Children's — one of the largest and most experienced pediatric glioma programs in the world. Our glioma specialists — a team of neuro-oncologists, surgeons, pathologists, neurologists, ophthalmologists, endocrinologists, and radiation oncologists — focus solely on the care of children diagnosed with gliomas. We also offer families the chance to have their child's tumor molecularly profiled (as long as a biopsy can be taken), which may help identify opportunities for targeted treatment.