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Treatment for gliomas in children

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, whether it is possible to operate, and the age of the child.

The main treatment for most childhood gliomas is surgery to remove as much of the tumour as possible. For some types of glioma, surgery may be the only treatment your child needs, particularly for slow growing (low grade) tumours. If the surgeon cannot remove all of the tumour they may suggest monitoring your child with scans to see if the tumour grows again. Or the doctor may suggest treatment with radiotherapy or chemotherapy or possibly a combination of both. Sometimes it is possible to carry out more surgery. 

Radiotherapy is not usually used for children under the age of 3 because it can cause long term side effects. But chemotherapy often works very well for these children.

Some areas of the brain are too delicate to operate on easily, such as parts of the brain stem and along the path of the eyesight nerves (optic nerves). Surgeons may try to remove small tumours in these areas. Or they may suggest treatment with radiotherapy or chemotherapy. 

If childhood glioma comes back

Unfortunately childhood gliomas can come back some time after they have first been treated. The treatment for a brain tumour that has come back depends on the treatment that 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.

 

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Factors in deciding treatment

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
  • Whether it is possible to remove it
  • The age of the child

The main treatment for most childhood gliomas is surgery to remove as much of the tumour as possible. After the surgery, your child's specialist may suggest radiotherapy or chemotherapy or possibly a combination of both. Radiotherapy is not usually used for children under the age of 3 because it can cause long term side effects. Your child's surgical and medical specialists will discuss all the treatment options with you in detail.

 

Gliomas in the cerebrum

The cerebrum is the largest part of the brain. It is also called the forebrain and is divided into 2 halves – the right and left cerebral hemispheres. Each cerebral hemisphere is divided into 4 areas called the frontal lobe, temporal lobe, parietal lobe and occipital lobe. You can see these areas in the diagram above. 

Gliomas in the cerebrum 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 low grade tumours that have not been completely removed, or if the tumour is high grade, your specialist will decide between radiotherapy or chemotherapy. They may then recommend more surgery

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

 

Gliomas in the cerebellum

The cerebellum is the back part of the brain. it is coloured purple in the diagram above. It is also called the posterior fossa or hindbrain. Gliomas in the cerebellum 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 tumour with MRI scans 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.

 

Gliomas in the brain stem

These tumours can be very difficult to treat. The brain stem is a very delicate area that controls many vital body functions. It includes an area called the midbrain. As the brain stem controls any vital body functions it is not always possible to operate in this area. 

Gliomas in the brain stem can be slow growing and just in one area (these are called called focal tumours). Other tumours are faster growing and tend to grow into the surrounding brain tissue (called diffuse tumours). There are various sub types of brain stem glioma. 

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 treatment if they are not causing symptoms. 

Some tumours are very small, but cause fluid to collect around the brain (hydrocephalus). If this happens, your child's doctor may suggest that they put in a tube to drain the fluid, but they may give no other treatment until the tumour grows. There is 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 because this can work well for these tumours in young children. They delay giving radiotherapy until the child is older. Fortunately brain stem gliomas are very rare in young children.

 

Gliomas of the eyesight nerves

The eyesight nerves are also called the visual nerves or the optic pathway. Gliomas in this area are most often quite slowly 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 grow so slowly that they may not cause any symptoms or problems for years. This is most often the case with tumours in children who have the genetic condition neurofibromatosis.

If there is any risk that the child may lose their eyesight they need to have treatment. Their 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
 

Gliomas that come back

Unfortunately childhood gliomas can come back some time after they have first been treated. The treatment for a brain tumour that has come back depends on the treatment that 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.

 

Radiotherapy in young children with glioma

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 found that chemotherapy can work very well for some types of glioma in babies and young children. 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 glioma from coming back.

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.

 

More information about childhood glioma treatment

If you would like more information about childhood glioma treatment you may find it in our section about brain tumour treatment.

You can find information about the outlook (prognosis) for these tumours on the brain tumour statistics and outlook page

You are also welcome to contact the Cancer Research UK nurses on freephone 0808 800 4040. Lines are open from 9am to 5pm, Monday to Friday. 

You can contact one of the brain tumour organisations or look at our brain tumour reading list. If you want to find people to share experiences with online, you could use CancerChat, our online forum.

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Updated: 11 December 2013