Treatment of Pediatric Brain tumors.

1. Dr. Amit Vatkar
MBBS, DCH, DNB Pediatrics
Fellow in Pediatric Neurology, Mumbai
Trained in Neurophysiology & Epilepsy, USA
Contact No. : +91-8767844488
Email: vatkaramit@yahoo.com
MANAGEMENT OF
CHILDHOOD BRAIN
TUMORS

2. INVESTIGATIONS
• Routine Investigations
• X-ray of Skull
Hydrocephalus – Sutural diastasis,erosion of
posterior clinoid,
Beaten silver appearance
Calcifications – Craniopharyngioma,
ependymoma,
Oligodendroglioma

3. • CT Brain
- Less time consuming
- Calcifications
• MRI Brain
- Better delineation of tumors
- Highly sensitive for brain stem and posterior fossa tumors
- No radiation hazard

4. Pilocytic astrocytoma
CT scan
Mri Plain MRI Contrast

5. EPENDYOMA
EPENDYOMA CT
MRI PLAIN
MRI CONTAST

6. MEDULLOBLASTOMA MRI PLAIN
MEDULLOBLASTOMA MRI COTRAST

7. CRANIOPHARYMGIOMA CT
CRANIOPHAYRNGIOMA MRI PLAIN
• CRANIOPHAYRNGIOMA MRI PLAIN
CRANIOPHAYRNGIOMA MRI CONTRAST

8. CHOROID PLEXUS PAPILLOMA CT
PLAIN CHOROID PLEXUS PAPILLOMA CT CONTRAST

9. PONTINE GLIOMA CT PLAIN PONTINE GLIOMA CT CONTRAST

10. • CSF analysis – Medulloblastoma, Ependymoma
Germ cell tumors
• Immunopositivity - transthyretin (prealbumin) positive in choroid
plexus tumors
• AFP & Beta HCG - In serum and CSF for germ cell tumors
• Endocrine evaluation - craniopharyngiomas

11. • MR spectroscopy,PET,SPECT scan – variation in the metabolism of
Tumors cells and normal brain tissue
• Myelography
• Biopsy

12. TREATMENT
• Supportive
• Specific
Surgery
Radiotherapy
Chemotherapy
 Newer techniques

13. Supportive
Measures to reduce ICP
• Head elevation
• Hyperventilation
• Hypothermia
• Osmotic diuretics – 20% mannitol 0.25g/kg

14. • Corticosteroids – 0.1 to 0.2mg/kg 6th hrly
• Acetazolamide & frusemide
- Anticonvulsive drugs – phenobarbitone
- Shunting procedures for Hydrocephalus

15. Specific
• Surgery
- Primary modality of treatment
- Good prognosis if complete surgical removal is possible. Pilocytic
Astrocytoma, Choroid plexus papilloma
- Not possible in pontine glioma, Germ cell tumors and pineal tumors

16. • Radiotherapy:
- Tumor cannot be removed surgically
- Residual tumor
- Craniospinal irradiation – Medulloblastoma,
Ependymoma,Germ
Cell tumors,
Pineoblastoma
- Avoid <4yrs

17. • Chemotherapy:
- Adjuvant therapy to surgery
- In children <4yrs to delay radiotherapy
- Some chemosensitive tumors – Pineal tumors, Medulloblastoma,
ependymoma, Astrocytoma

18. Newer techniques
• Steriotactic radiosurgery
• Intensity modulated radiation therapy
• Gene therapy – high grade gliomas
• High dose chemotherapy

19. • Growth factor inhibitors
• Angiogenesis inhibitors
• Radiosensitizers
• Immunotherapy

20. PROGNOSIS
• Size and location of the tumor
• Grade of tumor
• Age of child
• Metastasis at diagnosis
• Residual tumors

21. Name & location
of cells
Survival Rates Treatment
Medulloblastoma
(cerebellum)
50 percent after
five years
Surgery, radiation, chemotherapy, clinical trials.
Recurrent cancer: Stem cell transplant.
Cerebellar astrocytoma
(cerebellum)
90 percent after
five years
Surgery, radiation after repeat surgical
procedures.
Recurrent cancer: Surgery first, then radiation,
chemotherapy only if surgery and radiation are
not working, clinical trials.
Infratentorial ependymoma
(fourth ventricle
and spinal cord cavity)
50 percent after
five years
Surgery and radiation following, possible use of
chemotherapy for young children.
Recurrent cancer: Poor response to surgery and
radiotherapy, cisplatin chemotherapy works for
one third of patients, clinical trails should be
considered.
Brain stem glioma
(brain stem)
Most patients
die in 18 months
Usually cannot be surgically removed; use
radiation, not chemotherapy except for children
under three to delay radiation.
Recurrent cancer: No surgery, no chemotherapy
and no radiation, maximum has already been
administered. Clinical drug trials are only
option.

22. Name & location
of cells
Survival Rates Treatment
Cerebral astrocytoma, low
grade (cerebrum)
Over 80 percent
after five years
Surgery, radiation and chemotherapy only if
not surgically removed.
Recurrent cancer: Chemotherapy after
maximum surgery and radiation, clinical trials.
Cerebral astrocytoma,
high grade (cerebrum)
20-50 percent
after five years
Surgery, radiation and chemotherapy.
Chemotherapy is used for children under three
to delay radiation.
Recurrent cancer: Chemotherapy after
radiation, clinical trials.
Supratentorial
ependymoma
(back of the brain and
adjacent ventricles)
50 percent after
five years
Surgery followed by radiation. Chemotherapy
to delay radiation for very young children.
Recurrent cancer: Seldom controlled after
surgery and radiation. Cisplatin chemotherapy
works for one-third of patients. Clinical trails
should be considered.
Craniopharyngioma (benign
tumors
in the central
brain tissue)
Unknown Surgery is usually successful. Recurrent
cancer: Radiation.

23. Name & location
of cells
Survival Rates Treatment
Intracranial germ cell
tumor
Variable No surgery. Chemotherapy and radiation.
Recurrent cancer: Chemotherapy, clinical
trials.
Recurrent cancer: Chemotherapy, clinical
trials.
Pineal tumors
(pineal gland,
undifferentiated cells)
50 percent after
five years
Radiation and chemotherapy. Surgery is not
possible. Chemotherapy to delay radiation
for very young children.
Optic tract glioma (optic
nerves,
create visual symptoms)
Unknown For younger children: chemotherapy, then
radiation if chemo fails. Radiation earlier for
older children. Observation.

24. THANK YOU