Skip to main content
SpringerLink
Log in

Hirntumoren im Kindesalter

Diagnostik und interdisziplinäre Therapiekonzepte

Brain tumors in children

Diagnostics and interdisciplinary therapeutic strategies

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

In Deutschland erkranken jährlich etwa 380 Kinder und Jugendliche unter 16 Jahren an einem Hirntumor. Das Spektrum der Hirntumoren unterscheidet sich dabei erheblich von dem erwachsener Patienten. Die Diagnosestellung erfolgt trotz charakteristischer Symptome oft verzögert. Daher sind unspezifische Symptome bei Persistenz weiter abzuklären. Seit den 80er Jahren werden im Auftrag der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) multimodale Behandlungskonzepte in Therapie(optimierungs)studien systematisch weiterentwickelt. Je nach Histologie, Metastasierungsgrad und Alter kommen dabei Operation, Chemotherapie und Bestrahlung in zunehmend differenzierter Form zum Einsatz. Derzeit werden 80–90% der in Deutschland an Hirntumoren erkrankten Kinder im Rahmen des „Behandlungsnetzwerks HIT“ behandelt. Hauptziele sind die Verbesserung von Überlebensraten und Lebensqualität sowie die Verminderung von therapieassoziierter Toxizität und Spätfolgen. Im Folgenden werden typische Leitsymptome, diagnostische Empfehlungen und aktuelle Therapiestrategien vorgestellt.

Abstract

About 380 children younger than 16 years of age are diagnosed with a brain tumor in Germany every year. Compared to adults, different types of brain tumors are found in children. The diagnosis is often delayed in spite of presentation with characteristic symptoms. Unspecific persistent symptoms must be followed by further diagnostics. Since the 1980s, multimodal therapeutic regimens have been developed systematically by the Society for Pediatric Oncology and Hematology (GPOH) in the context of treatment optimalization trials. Neurosurgery, chemotherapy and irradiation are applied according to histology, stage of metastasis, and the age of the children. Currently, 80–90% of children diagnosed with a brain tumor in Germany are treated according to the respective trial in the context of the ‘treatment network HIT’. The principle aims are improved survival and quality of life, and the reduction of therapy-associated toxicity and late-effects. In this article, typical clinical symptoms, diagnostic recommendations and current treatment strategies are described.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Bartels U, Hargrave D, Lau L, Esquembre C, Humpl T, Bouffet E (2003) Analysis if paediatric neuro-oncological information on the Internet in German language. Klin Pädiatr 215:352–357

    Google Scholar 

  2. Creutzig U, Henze G, Bielack S, Herold R, Kaatsch P, Klussmann JH, Graf N, Reinhardt D, Schrappe M, Zimmermann M, Jürgens H (2003) Krebserkrankungen bei Kindern. Erfolg durch einheitliche Therapiekonzepte seit 25 Jahren. Deutsches Ärzteblatt 100 (13):A–842

    Google Scholar 

  3. Gnekow AK, Kaatsch P, Kortmann R, Wiestler OD (2000) HIT-LGG: effectiveness of carboplatin-vincristine in progressive low-grade gliomas of childhood--an interim report. Klin Pädiatr 212:177–184

    Google Scholar 

  4. Gnekow AK, Kortmann RD, Pietsch T, Emser A (2004) Low grade chiasmatic-hypothalamic glioma-carboplatin and vincristin chemotherapy effectively defers radiotherapy within a comprehensive treatment strategy — report from the multicenter treatment study for children and adolescents with a low grade glioma — HIT-LGG 1996 — of the Society of Pediatric Oncology and Hematology (GPOH). Klin Pädiatr 216:331–342

    Google Scholar 

  5. Jacobi G, Korinthenberg R, Kühl J (2004) Leitsymptome und Diagnostik der Hirntumoren im Kindes- und Jugendalter. In: Schmidt-Reißer B, Schulenberg D (Hrsg) Deutsche Krebsgesellschaft e.V. Diagnostik und Therapie maligner Erkrankungen. Kurzgefasste Interdisziplinäre Leitlinien 2004, 4. Aufl. Zuckschwerdt, München Wien New York, S 449–458

  6. Kaatsch P, Rickert CH, Kühl J, Schuz J, Michaelis J (2001) Population-based epidemiologic data on brain tumors in German children. Cancer 92:3155–164

    Article  PubMed  Google Scholar 

  7. Kleihues P, Cavanee WK (2000) Tumours of the Nervous System. Pathology and Genetics. World Health Organisation Classification of Tumours. IARC Press, Lyon

  8. Kortmann RD, Kühl J, Timmermann B et al. (2000) Postoperative neoadjuvant chemotherapy before radiotherapy as compared to immediate radiotherapy followed by maintenance chemotherapy in the treatment of medulloblastoma in childhood: results of the German prospective randomized trial HIT ‚91. Int J Radiat Oncol Biol Phys 46:269–179

    Article  PubMed  Google Scholar 

  9. Kortmann RD, Timmermann B, Taylor RE et al. (2003) Current and future strategies in radiotherapy of childhood low-grade glioma of the brain. Part I: Treatment modalities of radiation therapy. Strahlenther Onkol 179:509–520

    Article  PubMed  Google Scholar 

  10. Müller HL, Bueb K, Bartels U et al. (2001) Obesity after childhood craniopharyngioma--German multicenter study on pre-operative risk factors and quality of life. Klin Pädiatr 213:244–249

    Google Scholar 

  11. Müller HL, Emser A, Faldum A et al. (2004) Longitudinal study on growth and body mass index before and after diagnosis of childhood craniopharyngioma. J Clin Endocrinol Metab 89:3298–305

    Article  PubMed  Google Scholar 

  12. Müller HL, Gebhardt U, Etavard-Gorris N et al. (2004) Prognosis and sequela in patients with childhood craniopharyngioma — results of HIT-ENDO and update on Kraniopharyngeom 2000. Klin Pädiatr 216:343–348

    Google Scholar 

  13. Radner H, Blumcke I, Reiffenberger G, Wiestler OD (2002) The new WHO classification of tumors of the nervous system 2000. Pathology and genetics. Pathologe 23:260–283

    Article  PubMed  Google Scholar 

  14. Rood BR, MacDonald TJ, Packer R (2004) Current treatment of medulloblastoma: recent advances and future challenges. Semin Oncol 31:666–675

    PubMed  Google Scholar 

  15. Rutkowski S, Bode U, Deinlein F et al. (2005) Treatment of early childhood medulloblastoma by postoperative chemotherapy alone. N Engl J Med 352:978–986

    Article  PubMed  Google Scholar 

  16. Timmermann B, Kortmann RD, Kühl J, Meisner C, Dieckmann K, Pietsch T, Bamberg M (2002) Role of radiotherapy in the treatment of supratentorial primitive neuroectodermal tumors in childhood: results of the prospective randomised trials HIT 88/89 and 91. J Clin Oncol 20:842–849

    Article  PubMed  Google Scholar 

  17. Timmermann B, Kortmann RD, Kühl J, Meisner C, Slavc I, Pietsch T, Bamberg M (2000) Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91. Int J Radiat Oncol Biol Phys 46:287–295

    Article  PubMed  Google Scholar 

  18. Warmuth-Metz M, Gnekow A, Muller H, Solymosi L (2004) Differential diagnosis of suprasellar tumors in children. Klin Pädiatr 216:323–330

    Google Scholar 

  19. Warmuth-Metz M, Kühl J, Rutkowski S, Krauss J, Solymosi L (2003) Differential infratentorial brain tumor diagnosis in children. Radiologe 43:977–985

    Article  PubMed  Google Scholar 

  20. Wolff JEA, Gnekow A, Kortmann RD, Kuehl J, Urban C, Graf N (2002) Preradiation chemotherapy for pediatric patients with high-grade glioma. Cancer 94:264–271

    Article  PubMed  Google Scholar 

  21. Wolff JEA, Mölenkamp G, Westphal S, Pietsch T, Gnekow A, Kortmann RD, Kuehl J (2000) Oral trofosfamide and etoposide in pediatric patients with glioblastoma multiforme. Cancer 89:2131–217

    Article  PubMed  Google Scholar 

  22. Wolff JEA, Sajedi M, Brant R, Coppes MJ, Egeler RM (2002) Choroid plexus tumors. Br J Cancer 87:1086–1091

    Article  PubMed  Google Scholar 

  23. Wolff JE, Westphal S, Mölenkamp G, Gnekow A, Warmuth-Metz M, Rating D, Kuehl J (2002) Treatment of pediatric pontine glioma with oral trophosphamide and etoposide. Br J Cancer 87:945–949

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Pädiatrische Onkologie, Kinderklinik und Poliklinik des Universitätsklinikums Würzburg

    S. Rutkowski

  2. Abt. für Neuroradiologie, Universität Würzburg

    M. Warmuth-Metz

  3. Abt. für Pädiatrische Neurochirurgie, Universität Würzburg

    N. Sörensen

  4. Pädiatrische Onkologie, Epidemiologie und Informatik, Universität Mainz

    A. Faldum

  5. Institut für Neuropathologie, Universität Bonn

    T. Pietsch

  6. Kinderklinik des Klinikums Oldenburg

    H. Müller

  7. Klinik für Kinder und Jugendliche, Klinikum Augsburg

    A. Gnekow

  8. Universitätskinderklinik Düsseldorf

    U. Göbel

  9. Dept. Pediatrics, Section Ped. Neurooncology, MD Anderson Cancer Center, University of Texas, USA

    J. Wolff

  10. Universitätskinderklinik Bonn

    G. Fleischhack

  11. Klinik für Strahlentherapie und Radioonkologie der Universität Leipzig

    R. Kortmann

  12. Pädiatrische Onkologie, Kinderklinik und Poliklinik des Universitätsklinikums Würzburg, Josef-Schneider-Straße 2, 97 080, Würzburg

    S. Rutkowski

Authors
  1. S. Rutkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Warmuth-Metz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Sörensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Faldum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Pietsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Gnekow
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. U. Göbel
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Fleischhack
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. R. Kortmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Rutkowski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rutkowski, S., Warmuth-Metz, M., Sörensen, N. et al. Hirntumoren im Kindesalter. Onkologe 11, 1090–1100 (2005). https://doi.org/10.1007/s00761-005-0930-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-005-0930-5

Schlüsselwörter

Keywords

Search

Navigation