There are different types of treatment for children who have central nervous system (CNS) embryonal tumors.
Children who have CNS embryonal tumors should have their treatment planned by a team of health care providers who are experts in treating brain tumors in children.
Childhood brain tumors may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years.
Some cancer treatments cause side effects months or years
after treatment has ended.
Five types of treatment are used:
Surgery
Radiation therapy
Chemotherapy
High-dose chemotherapy with stem cell rescue
Targeted therapy
New types of treatment are being tested in clinical trials.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
There are different types of treatment for children who have central nervous system (CNS) embryonal tumors.
Different types of treatment are available for children with central nervous system
(CNS) embryonal tumors. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study
meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children who have CNS embryonal tumors should have their treatment planned by a team of health care providers who are experts in treating brain tumors in children.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatrichealth care providers
who are experts in treating children with brain tumors
and who specialize in certain areas of medicine. These may include the following specialists
:
Childhood brain tumors may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years.
Signs
or symptoms
caused by the tumor
may begin before the cancer is diagnosed
and continue for months or years. It is important to talk with your child's doctors about signs or symptoms caused by the tumor that may continue after treatment.
Some cancer treatments cause side effects months or years
after treatment has ended.
Side effects
from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:
Physical problems.
Changes in mood, feelings, thinking, learning, or memory.
Loss of balance, trouble walking, and worsening handwriting.
Loss of muscle tone.
Mood swings and changes in personality.
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ
summary on Late Effects of Treatment for Childhood Cancer for more information).
Five types of treatment are used:
Surgery
Surgery is used to diagnose and treat a childhood CNS embryonal tumor as described in the General Information section of this summary.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy
and/or radiation therapy after surgery to kill any cancer cells
that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of radiation therapy:
External radiation therapy
uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of radiation therapy include the following:
Conformal radiation therapy
: Conformal radiation therapy is a type of external radiation therapy that uses a computer to make a 3-dimensional
(3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose
of radiation to reach the tumor and causes less damage to nearby healthy tissue.
Stereotactic radiation therapy
: Stereotactic radiation therapy is a type of external radiation therapy. A rigid head frame is attached to the skull
to keep the head still during the radiation treatment. A machine aims radiation directly at the tumor, causing less damage to nearby healthy tissue. The total dose of radiation is divided into several smaller doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
Radiation therapy to the brain can affect growth and development
in young children. For this reason, clinical trials are studying new ways of giving radiation that may have fewer side effects
than standard methods.
The way the radiation therapy is given depends on the type of cancer being treated. External radiation therapy is used to treat childhood CNS embryonal tumors.
Because radiation therapy can affect growth and brain development in young children, especially children who are three years old or younger, chemotherapy may be given to delay or reduce the need for radiation therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected
into a vein
or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity
such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy
is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type of cancer being treated.
Regular dose anticancer drugs given by mouth or vein to treat central nervous system tumors
cannot cross the blood-brain barrier
and enter the fluid
that surrounds the brain and spinal cord. Instead, an anticancer drug is injected into the fluid-filled space to kill cancer cells that may have spread there. This is called intrathecal
or intraventricular chemotherapy.Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to inject the drugs into an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). The other way, shown in the bottom part of the figure, is to inject the drugs directly into the CSF in the lower part of the spinal column, after a small area on the lower back is numbed.
High-dose chemotherapy with stem cell rescue
High-dose chemotherapy
with stem cell rescue
is a way of giving high doses of chemotherapy and replacing blood
-forming cells destroyed by the cancer treatment. Stem cells
(immature blood cells) are removed from the blood or bone marrow
of the patient or a donor
and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Targeted therapy
Targeted therapy
is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.
Signal transduction inhibitors
are a type of targeted therapy used to treat recurrent
medulloblastoma. Signal transduction inhibitors block signals that are passed from one molecule
to another inside a cell. Blocking these signals may kill cancer cells. Vismodegib
is a type of signal transduction inhibitor.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI website.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring
(coming back) or reduce the side effects
of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's
listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. (See the General Information section for a list of tests.) Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the imaging tests
will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition
has changed or if the brain tumor has recurred
(come back). If the imaging tests show abnormal
tissue in the brain, a biopsy
may also be done to find out if the tissue is made up of dead tumor cells or if new cancer cells are growing. These tests are sometimes called follow-up
tests or check-ups.
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