Treatment for gliomas in children

Childhood gliomas can be in 

• The forebrain
• The hindbrain
• The brain stem
• The eyesight nerve pathways

The treatment for gliomas in children depends on

• Whether the tumour is slow or fast growing (the grade)
• Where in the brain the tumour is growing
• The age of the child

The main treatment for most childhood gliomas is surgery to remove as much of the tumour as possible. But it isn't possible to remove tumours in some areas of the brain. For example, with tumours in the brain stem or along the path of the eyesight nerves (optic nerve tumours), surgery can cause too much damage to the surrounding normal brain tissue. These parts of the brain are delicate, important and highly specialised areas.

If surgery is possible, low grade tumours are generally easier to remove than high grade because they tend to be more compact. Low grade tumours don't spread out into the surrounding brain tissue in the way that some high grade tumours do. For some types of glioma, surgery may be the only treatment your child needs, particularly for slow growing (low grade) tumours.

If your child can't have the complete tumour removed, your specialist may suggest radiotherapy or chemotherapy or possibly a combination of both. Of course, your child's surgical and medical specialists will discuss all the treatment options with you in much more detail. Radiotherapy is not used for children under the age of 3 because it can cause long term side effects. 

Forebrain gliomas can be slow or fast growing. It is often possible for surgeons to remove the slow growing ones. If your surgeon can remove the tumour completely, this may be the only treatment your child needs. If surgery to remove a low grade tumour is not possible, your specialist may decide to delay further treatment and keep a close eye on your child with repeated scans, to see if the tumour begins to grow again. With other low grade tumours that have not been completely removed, or if the tumour is high grade, your specialist will decide between

• More surgery
• Radiotherapy
• Chemotherapy

Choosing treatment is a decision that has to be made individually for your child by their specialist team of doctors, as there are so many things to be taken into account. Sometimes specialists prefer to use chemotherapy in very young children, so that they can delay radiotherapy until the child is older.

Hindbrain or cerebellar gliomas are nearly all low grade. The main treatment is surgery and about 9 out of 10 can be completely removed. If the tumour is not completely removed, your specialist may decide to monitor the situation and delay treatment until there are signs that it is growing again. Or your child's specialist may suggest radiotherapy or chemotherapy straight away. Sometimes it is possible to carry out more surgery.

The problem with tumours in the brain stem is that this is a very delicate area that controls many vital body functions. So it is not always possible to operate. Gliomas in the brain stem can be slow growing and confined to one area (called focal). Others are faster growing and tend to grow into the surrounding brain tissue (called diffuse). The brain stem includes an area called the midbrain.

If possible, surgeons remove focal type gliomas. Your child's specialist will then keep a very close eye on your child to see if any remaining tumour starts to grow again. Sometimes, the specialist may advise delaying surgery. Some tumours in this area grow so slowly that they don't really need treating if they are not causing symptoms. Some tumours are very small, but cause too much fluid to collect around the brain (hydrocephalus). Your child's doctor may suggest that they put in a tube to drain the fluid, but no other treatment until the tumour grows. There is more information about treating hydrocephalus in the surgery for brain tumours section.

Depending on their age, your child may have radiotherapy for a diffuse type glioma in the brain stem. For very young children, specialists tend to give chemotherapy and delay radiotherapy until the child is older. Fortunately brain stem gliomas are very rare in young children.

The eyesight nerves are also called the visual nerves or the optic pathway. Gliomas in this area are most often relatively slow growing (low grade). In some situations your child's specialist may suggest that your child does not have treatment straight away. Some of these tumours are very slow growing and may not cause any symptoms or problems for years. This is most often the case with tumours that are associated with the genetic condition neurofibromatosis.

If there is any risk that the child may lose their eyesight they need treatment and the specialist will try to remove as much of the tumour as possible. 

Surgery can be difficult in this area of the brain. If the tumour cannot be completely removed, your child's specialist may suggest

• Radiotherapy or chemotherapy straight away if your child is having problems with sight
• Chemotherapy to shrink the tumour, with radiotherapy delayed until your child is older

Unfortunately childhood gliomas can come back many years after they have first been treated. The treatment for a brain tumour that has come back depends on the treatment your child had first time round.

Your child's surgeon may be able to operate again. If your child didn't have radiotherapy before, then your specialist may suggest it now. If your child has had radiotherapy, they may still be able to have it again. Or their doctor may suggest chemotherapy instead.

Children under 3 with tumours in the front part of the brain are not treated with radiotherapy if at all possible. This is because their young age makes radiotherapy more likely to affect their brain development and give other long term side effects. Doctors and researchers have developed another way of treating glioma in babies and small children. The doctor may offer chemotherapy to keep your child's tumour under control until radiotherapy is less likely to cause damage. The exact combination of drugs used and the timing varies. But generally chemotherapy is given every 2 to 6 weeks. For children under 2 when they were diagnosed, the treatment continues for 2 years. After that, your child may have a course of radiotherapy to help stop the brain tumour from coming back.

It is only a few years since children first took part in this research. And trials are still going on. So it is early days for the long term results, but some doctors hope that radiotherapy may not be needed in some children who have had this chemotherapy treatment for at least a year.

Unfortunately, some brain tumours will come back during the chemotherapy. If this happens, your child's specialist will use radiotherapy to treat the tumour. There is detailed information about chemotherapy for brain tumours and radiotherapy for brain tumours in this section of the website.