The Indian Journal of Pediatrics

, Volume 78, Issue 12, pp 1510–1519 | Cite as

Management of Childhood Brain Tumors: Consensus Report by the Pediatric Hematology Oncology (PHO) Chapter of Indian Academy of Pediatrics (IAP)

  • Sunil Bhat
  • Satya Prakash Yadav
  • Vaishali Suri
  • Rana Patir
  • Purna Kurkure
  • Stewart Kellie
  • Anupam Sachdeva
Special Article

Abstract

Brain tumors are the second most common childhood tumors and remain the leading cause of cancer related deaths in children. Appropriate diagnosis and management of these tumors are essential to improve survival. There are no clinical practical guidelines available for the management of brain tumors in India. This document is a consensus report prepared after a National Consultation on Pediatric Brain Tumors held in Delhi on 06 Nov 2008. The meeting was attended by eminent experts from all over the country, in the fields of Neurosurgery, Radiation Oncology, Pediatric Oncology, Neuropathology, Diagnostic Imaging, Pediatric Endocrinology and Allied Health Professionals. This article highlights that physicians looking after children with brain tumors should work as part of a multidisciplinary team to improve the survival, quality of life, neuro-cognitive outcomes and standards of care for children with brain tumors. Recommendations for when to suspect, diagnostic workup, initial management, long-term follow up and specific management of individual tumors are outlined.

Keywords

Pediatric brain tumor Diagnosis Management 

References

  1. 1.
    Rosemberg S, Fujiwara D. Epidemiology of pediatric tumors of the nervous system according to the WHO 2000 classification: a report of 1,195 cases from a single institution. Childs Nerv Syst. 2005;21:940–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. World Health Organization classification of tumors of the central nervous system. Lyon: IARC; 2007.Google Scholar
  4. 4.
    Vézina LG. Neuroradiology of childhood brain tumors: new challenges. J Neuro-Oncol. 2005;75:243–52.CrossRefGoogle Scholar
  5. 5.
    Johannessen AL, Torp SH. The clinical value of Ki-67/MIB-1 labeling index in human astrocytomas. Pathol Oncol Res. 2006;12:143–7.PubMedCrossRefGoogle Scholar
  6. 6.
    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;54:1886–93.PubMedGoogle Scholar
  7. 7.
    Munshi A, Jalali R. A simple technique of supine cranio spinal irradiation. Med Dosim. 2008;33:1–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Jalali R, Goswami S, Sarin R. Neuropsychological status in children and young adults with benign and low-grade brain tumors treated prospectively with focal stereo tactic conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2006;66:S14–9.Google Scholar
  9. 9.
    Albright AL, Sposto R, Holmes E, et al. Correlation of neurosurgical sub specialization with outcomes in children with malignant brain tumors. Neurosurgery. 2000;47:879–87.PubMedCrossRefGoogle Scholar
  10. 10.
    Robertson PL, Muraszko KM, Holmes EJ, et al. Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children’s Oncology Group. J Neurosurg. 2006;105(S6 Pediatrics):444–51.PubMedGoogle Scholar
  11. 11.
    Zeltzer PM, Boyett JM, Finlay JL, et al. Metastasis stage, adjuvant treatment, and residual tumor are prognostic factors for medulloblastoma in children: conclusions from the Children’s Cancer Group 921 randomized phase III study. J Clin Oncol. 1999;17:832–45.PubMedGoogle Scholar
  12. 12.
    Packer RJ, Gajjar A, Vézina G, et al. Phase III study of cranio spinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol. 2006;24:4202–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Murthy V, Jalali R, Sarin R, Nehru RM, Deshpande D, Dinshaw KA. Stereo tactic conformal radiotherapy for posterior fossa tumours: a modelling study for potential improvement in therapeutic ratio. Radiother Oncol. 2003;67:191–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Packer RJ, Sutton LN, Elterman R, et al. Outcome for children with Medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy. J Neurosurg. 1984;81:690–8.Google Scholar
  15. 15.
    Gajjar A, Chintagumpala M, Ashley D, et al. Risk-adapted cranio spinal radiotherapy followed by high-dose chemotherapy and stem cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96): long-term results from a prospective, multicenter trial. Lancet. 2006;7:813–20.CrossRefGoogle Scholar
  16. 16.
    Taylor RE, Bailey CC, Robinson K, et al. Results of a randomized study of pre radiation chemotherapy versus radiotherapy alone for nonmetastatic medulloblastoma: The International Society of Paediatric Oncology/United Kingdom Children’s Cancer Study Group PNET-3 Study. J Clin Oncol. 2003;21:1582–91.CrossRefGoogle Scholar
  17. 17.
    Kuhl J, Muller HL, Berthold F, et al. Pre radiation chemotherapy of children and young adults with malignant brain tumors: results of the German pilot trial HIT 088/089. Klin Pädiatr. 1998;210:227–33.PubMedCrossRefGoogle Scholar
  18. 18.
    Kurkure P, Arora, Sarin R, et al. Concomitant chemo radiation in high-risk primitive CNS embryonal tumours prospective pilot study. Eur J Cancer. 2007;4:234.Google Scholar
  19. 19.
    Rutkowski S, Bode U, Deinlein F, et al. Treatment of early childhood medulloblastoma by postoperative chemotherapy alone. N Engl J Med. 2005;352:978–86.PubMedCrossRefGoogle Scholar
  20. 20.
    Geyer JR, Sposto R, Jennings M, et al. Multi agent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: a report from the Children’s Cancer Group. J Clin Oncol. 2005;23:7621–31.PubMedCrossRefGoogle Scholar
  21. 21.
    Ris MD, Packer R, Goldwein J, Jones-Wallace D, Boyett JM. Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for medulloblastoma: a Children’s Cancer Group study. J Clin Oncol. 2001;19:3470–6.PubMedGoogle Scholar
  22. 22.
    Mulhern RK, Kepner JL, Thomas PR, Armstrong FD, Friedman HS, Kun LE. Neuro Psychologic functioning of survivors of childhood medulloblastoma randomized to receive conventional or reduced-dose cranio spinal irradiation: a Pediatric Oncology Group study. J Clin Oncol. 1889;16:1723–8.Google Scholar
  23. 23.
    Gurney JG, Bunin GR. CNS and miscellaneous intracranial and intraspinal neoplasms. In: Ries LAG, Smith MA, Gurney JG, et al., editors. Cancer incidence and survival among children and adolescents: United States SEER Program 1975–1995.NIHPubNo99–4649. Bethesda: National Cancer Institute SEER Program; 1999. p. 51–63.Google Scholar
  24. 24.
    Finizio FS. CT and MRI aspects of supratentorial hemispheric tumors of childhood and adolescence. Childs Nerv Syst. 1995;11:559–67.PubMedCrossRefGoogle Scholar
  25. 25.
    Pollack IF. The role of surgery in pediatric gliomas. J Neurooncol. 1999;42:271–88.PubMedCrossRefGoogle Scholar
  26. 26.
    Ciurea AV, Vasilescu G, Nuteanu L, Silveanu-Vladu M, Teodorescu I, Lisievici M. Neurosurgical management of cerebral astrocytomas in children. Ann NY Acad Sci. 1997;824:237–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Marchese MJ, Chang CH. Malignant astrocytic gliomas in children. Cancer. 1990;65:2771–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Wolff JE, Gnekow AK, Kortmann RD, et al. Pre radiation chemotherapy for pediatric patients with high-grade glioma. Cancer. 2002;94:264–71.PubMedCrossRefGoogle Scholar
  29. 29.
    Wisoff JH, Boyett JM, Berger MS, et al. Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children’s Cancer Group trial no. CCG-945. J Neurosurg. 1998;89:52–9.PubMedCrossRefGoogle Scholar
  30. 30.
    MacDonald TJ, Arenson E, Sposto R, et al. Phase II study of high-dose chemotherapy before radiation in children with newly diagnosed high-grade astrocytoma: final analysis of Children’s Cancer Group study 9933. Cancer. 2005;104:2862–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Burger PC, Cohen KJ, Rosenblum MK, Tihan T. Pathology of diencephalic astrocytomas. Pediatr Neurosurg. 2000;32:214–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Gropman AL, Packer RJ, Nicholson HS, et al. Treatment of diencephalic syndrome with chemotherapy: growth, tumor response, and long-term control. Cancer. 1998;83:166–72.PubMedCrossRefGoogle Scholar
  33. 33.
    Packer RJ. Chemotherapy: low-grade gliomas of the hypothalamus and thalamus. Pediatr Neurosurg. 2000;32:259–63.PubMedCrossRefGoogle Scholar
  34. 34.
    Mandell LR, Kadota R, Freeman C, et al. There is no role for hyper fractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brainstem tumors: results of a pediatric oncology group phase III trial comparing conventional vs. hyper fractionated radiotherapy. Int J Radiat Oncol Biol Phys. 1999;43:959–64.PubMedCrossRefGoogle Scholar
  35. 35.
    Jalali R, Raut N, Arora B, et al. Prospective evaluation of radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma. Int J Radiat Oncol Biol Phys. 2010;77:113–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Farmer JP, Montes JL, Freeman CR, Meagher-Villemure K, Bond MC, O’Gorman AM. Brainstem gliomas. A 10-year institutional review. Pediatr Neurosurg. 2001;34:206–14.PubMedCrossRefGoogle Scholar
  37. 37.
    Rubin G, Michowitz S, Horev G, Herscovici Z, Cohen IJ, Shuper A, et al. Pediatric brain stem gliomas: an update. Childs Nerv Syst. 1998;14:167–73.PubMedCrossRefGoogle Scholar
  38. 38.
    Robertson PL, Zeltzer PM, Boyett JM. Survival and prognostic factors following radiation therapy and chemotherapy for ependymoma in children: a report of the Children’s Cancer Group. J Neurosurg. 1998;88:695–703.PubMedCrossRefGoogle Scholar
  39. 39.
    Horn B, Heideman R, Geyer R. A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors. J Pediatr Hematol Oncol. 1999;21:203–11.PubMedCrossRefGoogle Scholar
  40. 40.
    Bouffet E, Perilongo G, Canete A, Massimino M. Intracranial ependymomas in children: a critical review of prognostic factors and a plea for cooperation. Med Pediatr Oncol. 1998;30:319–29.PubMedCrossRefGoogle Scholar
  41. 41.
    Pollack IF, Gerszten PC, Martinez AJ, et al. Intracranial ependymomas of childhood: long-term outcome and prognostic factors. Neurosurgery. 1995;37:655–66.PubMedCrossRefGoogle Scholar
  42. 42.
    Merchant TE, Mulhern RK, Krasin MJ, et al. Preliminary results from a phase II trial of conformal radiation therapy and evaluation of radiation-related CNS effects for pediatric patients with localized ependymoma. J Clin Oncol. 2004;22:3156–62.PubMedCrossRefGoogle Scholar
  43. 43.
    Needle MN, Goldwein JW, Grass J, et al. Adjuvant chemotherapy for the treatment of intracranial ependymoma of childhood. Cancer. 1997;80:341–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Massimino M, Giangaspero F, Garrè ML, et al. Salvage treatment for childhood ependymoma after surgery only: pitfalls of omitting at once adjuvant treatment. Int J Radiat Oncol Biol Phys. 2006;65:1440–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Sands SA, Milner JS, Goldberg J, Mukhi V, Moliterno JA, Maxfield C, et al. Quality of life and behavioral follow-up study of pediatric survivors of craniopharyngioma. J Neurosurg. 2005;103:302–11.PubMedGoogle Scholar
  46. 46.
    Jalali R, Budrukkar A, Sarin R, Sharma DS. High precision conformal radiotherapy employing conservative margins in childhood benign and low-grade brain tumours. Radiother Oncol. 1995;74:37–44.CrossRefGoogle Scholar
  47. 47.
    Merchant TE, Kiehna EN, Kun LE, et al. Phase II trial of conformal radiation therapy for pediatric patients with craniopharyngioma and correlation of surgical factors and radiation dosimetry with change in cognitive function. J Neurosurg. 2006;104:94–102.PubMedGoogle Scholar
  48. 48.
    Kobayashi T, Kida Y, Mori Y, Hasegawa T. Long-term results of gamma knife surgery for the treatment of craniopharyngioma in 98 consecutive cases. J Neurosurg. 2005;102:428–88.Google Scholar
  49. 49.
    Balmaceda C, Modak S, Finlay J. Central nervous system germ cell tumors. Semin Oncol. 1998;25:243–50.PubMedGoogle Scholar
  50. 50.
    Packer RJ, Cohen BH, Cooney K. Intracranial germ cell tumors. Oncologist. 2000;5:312–20.PubMedGoogle Scholar
  51. 51.
    Legido A, Packer RJ, Sutton LN, et al. Supra sellar germinomas in childhood. A reappraisal. Cancer. 1989;63:340–4.PubMedCrossRefGoogle Scholar
  52. 52.
    Bamberg M, Kortmann RD, Calaminus G, et al. Radiation therapy for intracranial germinoma: results of the German cooperative prospective trials MAKEI 83/86/89. J Clin Oncol. 1999;17:2585–92.PubMedGoogle Scholar
  53. 53.
    Bouffet E, Baranzelli MC, Patte C, et al. Combined treatment modality for intracranial germinomas: results of a multicentre SFOP experience. Société Française d’Oncologie Pédiatrique. Br J Cancer. 1999;79:1199–204.PubMedCrossRefGoogle Scholar
  54. 54.
    Balmaceda C, Heller G, Rosenblum M, et al. Chemotherapy without irradiation a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study. J Clin Oncol. 1996;14:2908–15.PubMedGoogle Scholar
  55. 55.
    Yoshida J, Sugita K, Kobayashi T. Treatment of intracranial germ cell tumors: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP16). Acta Neurochir Wien. 1993;120:111–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Berger C, Thiesse P, Lellouch-Tubiana A, Kalifa C, Pierre-Kahn A, Bouffet E. Choroid plexus carcinoma in childhood: clinical features and prognostic factors. Neurosurgery. 1998;42:470–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Pencalet P, Sainte-Rose C, Lellouch-Tubiana A, et al. Papillomas and carcinomas of the choroid plexus in children. J Neurosurg. 1998;88:521–8.PubMedCrossRefGoogle Scholar
  58. 58.
    McEvoy AW, Harding BN, Phipps KP, et al. Management of choroid plexus tumours in children: 20 years experience at a single neurosurgical center. Pediatr Neurosurg. 2000;32:192–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ. Radical excision of intra medullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000;93:183–93.PubMedCrossRefGoogle Scholar
  60. 60.
    Bouffet E, Pierre-Kahn A, Marchal JC, et al. Prognostic factors in pediatric spinal cord astrocytoma. Cancer. 1998;83:2391–9.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2011

Authors and Affiliations

  • Sunil Bhat
    • 1
  • Satya Prakash Yadav
    • 1
  • Vaishali Suri
    • 2
  • Rana Patir
    • 3
  • Purna Kurkure
    • 4
  • Stewart Kellie
    • 5
  • Anupam Sachdeva
    • 1
    • 6
  1. 1.Pediatric Hematology Oncology and BMT UnitSir Ganga Ram HospitalDelhiIndia
  2. 2.Department of PathologyAll India Institute of Medical SciencesDelhiIndia
  3. 3.Department of NeurosurgerySir Ganga Ram HospitalDelhiIndia
  4. 4.Department of Pediatric OncologyTata Memorial Cancer HospitalMumbaiIndia
  5. 5.Oncology UnitChildren’s Hospital at WestmeadSydneyAustralia
  6. 6.National Consultative on Brain Tumors, PHO Chapter of IAP, Pediatric Hematology Oncology and BMT Unit, Department of PediatricsSir Ganga Ram HospitalDelhiIndia

Personalised recommendations