Overview of the management of central nervous system tumors in children
- Ching Lau, MD, PhD
Ching Lau, MD, PhD
- Chief, Hematology Oncology at Connecticut Children's Medical Center
- Professor at Jackson Laboratory for Genomic Medicine
- Head of Division of Pediatric Hematology-Oncology, University of Connecticut School of Medicine
- Wan-Yee Teo, MBBS, FAAP, MRCPCH (UK), PhD
Wan-Yee Teo, MBBS, FAAP, MRCPCH (UK), PhD
- Assistant Professor
- Duke-NUS Graduate Medical School
Primary malignant central nervous system (CNS) tumors are the second most common childhood malignancies, after hematologic malignancies, and are the most common pediatric solid organ tumor (table 1) . It is the leading cause of death from childhood cancer, surpassing the mortality rate of acute lymphoblastic leukemia . Although advances in surgical intervention, radiotherapy, and chemotherapy have improved the survival rates in children with CNS tumors, mortality and morbidity associated with these disorders persist, especially with malignant brain tumors.
A general overview of the management and prognosis of CNS tumors in children will be reviewed here. The management and prognosis of the following specific CNS tumors that occur in children are discussed separately.
●Low-grade gliomas (see "Management of low-grade glioma")
●Malignant gliomas (see "Clinical manifestations and initial surgical approach to patients with high-grade gliomas")
- Linabery AM, Ross JA. Trends in childhood cancer incidence in the U.S. (1992-2004). Cancer 2008; 112:416.
- Ostrom QT, de Blank PM, Kruchko C, et al. Alex's Lemonade Stand Foundation Infant and Childhood Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2007-2011. Neuro Oncol 2015; 16 Suppl 10:x1.
- Albright AL, Sposto R, Holmes E, et al. Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors. Neurosurgery 2000; 47:879.
- Blaney SM, Hass-Kogan D, Poussaint TY, et al. Gliomas, ependymomas, and other nonembryonal tumors of the central nervous system. In: Principles and practice of pediatric oncology, 6th ed, Pizzo P, Poplack D (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.717.
- Hall WA, Truwit CL. 1.5 T: spectroscopy-supported brain biopsy. Neurosurg Clin N Am 2005; 16:165.
- Ahn ES, Goumnerova L. Endoscopic biopsy of brain tumors in children: diagnostic success and utility in guiding treatment strategies. J Neurosurg Pediatr 2010; 5:255.
- Matthews PM, Wylezinska M, Cadoux-Hudson T. Novel approaches to imaging brain tumors. Hematol Oncol Clin North Am 2001; 15:609.
- Yamaguchi F, Takahashi H, Teramoto A. Intra-operative detection of motor pathways using a simple electrode provides safe brain tumor surgery. J Clin Neurosci 2007; 14:1106.
- van Breemen MS, Wilms EB, Vecht CJ. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 2007; 6:421.
- Hardesty DA, Sanborn MR, Parker WE, Storm PB. Perioperative seizure incidence and risk factors in 223 pediatric brain tumor patients without prior seizures. J Neurosurg Pediatr 2011; 7:609.
- Sayegh ET, Fakurnejad S, Oh T, et al. Anticonvulsant prophylaxis for brain tumor surgery: determining the current best available evidence. J Neurosurg 2014; 121:1139.
- Glantz MJ, Cole BF, Forsyth PA, et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 54:1886.
- Plimpton SR, Stence N, Hemenway M, et al. Cerebral radiation necrosis in pediatric patients. Pediatr Hematol Oncol 2015; 32:78.
- Ostrom QT, Gittleman H, Liao P, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro Oncol 2014; 16 Suppl 4:iv1.
- Centers for Disease Control and Prevention (CDC). Trends in childhood cancer mortality--United States, 1990-2004. MMWR Morb Mortal Wkly Rep 2007; 56:1257.
- Morris EB, Gajjar A, Okuma JO, et al. Survival and late mortality in long-term survivors of pediatric CNS tumors. J Clin Oncol 2007; 25:1532.
- Armstrong GT, Liu Q, Yasui Y, et al. Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study. J Natl Cancer Inst 2009; 101:946.
- Gerber NU, Zehnder D, Zuzak TJ, et al. Outcome in children with brain tumours diagnosed in the first year of life: long-term complications and quality of life. Arch Dis Child 2008; 93:582.
- Mulhern RK, Merchant TE, Gajjar A, et al. Late neurocognitive sequelae in survivors of brain tumours in childhood. Lancet Oncol 2004; 5:399.
- Fouladi M, Gilger E, Kocak M, et al. Intellectual and functional outcome of children 3 years old or younger who have CNS malignancies. J Clin Oncol 2005; 23:7152.
- Landier W, Bhatia S, Eshelman DA, et al. Development of risk-based guidelines for pediatric cancer survivors: the Children's Oncology Group Long-Term Follow-Up Guidelines from the Children's Oncology Group Late Effects Committee and Nursing Discipline. J Clin Oncol 2004; 22:4979.
- Tsui K, Gajjar A, Li C, et al. Subsequent neoplasms in survivors of childhood central nervous system tumors: risk after modern multimodal therapy. Neuro Oncol 2015; 17:448.
- Friedman DL, Whitton J, Leisenring W, et al. Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst 2010; 102:1083.
- Lähteenmäki PM, Harila-Saari A, Pukkala EI, et al. Scholastic achievements of children with brain tumors at the end of comprehensive education: a nationwide, register-based study. Neurology 2007; 69:296.
- Ris MD, Beebe DW, Armstrong FD, et al. Cognitive and adaptive outcome in extracerebellar low-grade brain tumors in children: a report from the Children's Oncology Group. J Clin Oncol 2008; 26:4765.
- de Ruiter MA, van Mourik R, Schouten-van Meeteren AY, et al. Neurocognitive consequences of a paediatric brain tumour and its treatment: a meta-analysis. Dev Med Child Neurol 2013; 55:408.
- Bowers DC, Liu Y, Leisenring W, et al. Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study. J Clin Oncol 2006; 24:5277.
- Partap S. Stroke and cerebrovascular complications in childhood cancer survivors. Semin Pediatr Neurol 2012; 19:18.
- Passos J, Nzwalo H, Marques J, et al. Late Cerebrovascular Complications After Radiotherapy for Childhood Primary Central Nervous System Tumors. Pediatr Neurol 2015; 53:211.
- Vern-Gross TZ, Bradley JA, Rotondo RL, Indelicato DJ. Fertility in childhood cancer survivors following cranial irradiation for primary central nervous system and skull base tumors. Radiother Oncol 2015; 117:195.
- Armstrong GT, Whitton JA, Gajjar A, et al. Abnormal timing of menarche in survivors of central nervous system tumors: A report from the Childhood Cancer Survivor Study. Cancer 2009; 115:2562.
- Zebrack BJ, Gurney JG, Oeffinger K, et al. Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivor study. J Clin Oncol 2004; 22:999.
- Gurney JG, Krull KR, Kadan-Lottick N, et al. Social outcomes in the Childhood Cancer Survivor Study cohort. J Clin Oncol 2009; 27:2390.
- Zelcer S, Cataudella D, Cairney AE, Bannister SL. Palliative care of children with brain tumors: a parental perspective. Arch Pediatr Adolesc Med 2010; 164:225.
- MANAGEMENT STRATEGY
- Surgical approaches and techniques
- Preoperative and perioperative considerations
- - Increased ICP
- - Seizures
- - Endocrine abnormalities
- Long-term morbidity
- - Secondary neoplasms
- - Neurocognitive effects
- - Cerebrovascular disease
- - Endocrine abnormalities
- - Psychological effects
- - Social effects
- PALLIATIVE CARE
- SUMMARY AND RECOMMENDATIONS