Refining the treatments
Special Education teacher Brian Winston helps Arianne Del Rios with classwork at Trottier Middle School in Southboro, Mass.
Brain tumors in children are among the most feared diseases, but, fortunately, they are relatively rare. About 2,200 are diagnosed each year in the United States, according to the American Brain Tumor Association — most in children under age 7. Pediatric brain tumors are the second-leading cause of cancer death in children after leukemia.
The Institute's Pediatric Brain Tumor Clinic sees about 150 new patients each year. They receive checkups, chemotherapy, and other outpatient services at the Jimmy Fund Clinic, radiation therapy at Brigham and Women's Hospital, and inpatient care at Children's.
There are many tumor types. Among the most common are low-grade astrocytomas, medulloblastomas, highgrade gliomas, and ependymomas. Some types are nearly always fatal, while others are usually curable. In general, however, the outlook for children with brain tumors has brightened in the past two decades, thanks to refined surgery and improved chemotherapy and radiation.
A tumor and its treatment unavoidably damage normal brain tissue. Some children are so mildly affected that there's little outward sign, while others can barely care for themselves. Researchers are working to find more selective treatments, but until they do, physicians walk a delicate line as they try to reduce radiation doses — or avoid giving it to the youngest patients altogether — without compromising the tumor-killing impact of the therapies.
As one example of progress in the field, brain tumor specialists at Children's have been at the forefront of efforts to give radiation in highly focused beams that zap just the tumor and its surroundings, sparing as much normal brain tissue as possible.
"We have also been using chemotherapy to help kids live longer and reach an age when radiation would be less toxic," explains Scott Pomeroy, MD, director of Neurological Neuro-Oncology at Children's and a DFCI consultant. "At first the goal was age 7, and now it's greater than age 10. Some people are wondering whether we can actually replace radiation with chemotherapy."
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