The Brain Tumor Program: Advanced Care, Compassionate Environment
“Your child has a brain tumor.” For parents and loved ones, it’s a frightening diagnosis. But with timely and appropriate treatment, many of the 2,500 children and adolescents in the U.S. who are diagnosed with a brain tumor each year are able to live normal or near-normal lives.
Pediatric Brain Tumors: Different Challenges
Pediatric brain tumors, or neoplasms, come in many forms and are significantly different from adult brain tumors:
• They exhibit their own unique behaviors and degrees of malignancy
• They often reside in areas of the brain different from those of adults
Because the brain and nervous system grow and develop drastically during a child’s early years, some restrictions affect how to treat the tumor without injuring healthy tissue nearby or causing functional loss. Children with brain tumors require expert evaluation at a tertiary pediatric hospital, where a dedicated team of doctors and support staff access the latest clinical research, the sophisticated imaging technologies and the innovative evidence-based treatment modalities.A
Decade of Cancer Care
Cohen Children’s Medical Center is the only pediatric tertiary-level hospital on Long Island and is a recognized Center of Excellence nationally. Though our Brain Tumor Program is barely 10 years old, our growing reputation for advanced care and successful outcomes has led to a dramatic rise in pediatric patient referrals.
Each year we see many hundreds of cases, ranging in age from infant to age 18. Of these, perhaps 50 are newly evaluated tumor cases; the remaining patients receive ongoing treatment and follow-up. This concentration gives us an unparalleled advantage in treating each child we see.
A Complete Team of Caring Professionals
Our record of superior care begins with dedicated specialists who communicate as a team with each other and families. Our pediatric neuro-oncologists, neurosurgeons, neuroradiologists, radiation oncologists, social workers, psychologists, nutritionists and child life specialists are the most visible members of the coordinated brain tumor team, but experts in many other pediatric subspecialties such as pediatric anesthesiology and otolaryngology are called in as needed. Meeting as a Tumor Board every Tuesday, the principals discuss each patient’s current plan of treatment, constantly refining the details to reflect new science and the individual patient’s medical progress.
At the Brain Tumor Center we are also very mindful of the difficulties — emotional and practical — that a brain tumor diagnosis brings to the affected child and family, so we do our best to maintain an environment that is welcoming and reassuringly personal.
When patients and families — often traveling long distances — arrive for an appointment, every relevant member of the team is present to make the visit as efficient, informative and emotionally satisfying as possible. We recognize the key role that parents play in the success of our treatment plan and we make every effort to educate the family about each phase of treatment, what the benefits and side effects may be, and what lies ahead.
Treating the Unique Aspects of Each Tumor
Every tumor is unique and requires a customized treatment plan to find its target. Tumors may be malignant (cancerous, aggressive and capable of spreading) or benign (non-cancerous, typically contained and slow growing). They may also be primary (initiating in the brain) or metastatic (starting elsewhere in the body and later colonizing in the brain). Cell type, accessibility within the distinctly different regions of the brain and staging are other critical characteristics that shape treatment decisions going forward.
Medulloblastomas account for 30 to 40 percent of the pediatric tumors we see; these high-grade malignancies arise in the cerebellum, the region associated with movement and balance toward the base of the skull. Our results with medulloblastomas are among the best in the nation with a 95 percent disease-free survival rate in children considered of average risk. Astrocytomas, ependymomas, and craniopharyngiomas, account for most the rest of pediatric brain tumors. Staging is tied to the tumor’s development, with Stage 1 indicating early in development and thus more readily removed to Stages 4 and 5 which describe advanced metastatic tumors. A thorough evaluation including a patient history, an MRI and a pathology report, provide that information. Then a treatment plan takes shape.
The Treatment Plan
How a brain tumor is treated is based on a number of factors. When a neoplasm can be physically removed without damaging critical neurological functions such as sight or hearing or speech, surgery plays the primary role.
Craniotomy for Higher-Risk Tumors
Some surgical cases we see are emergent, as when a tumor at the back of the brain causes a sudden blockage of cerebrospinal fluid that can quickly lead to swelling and intracranial tissue damage. Our surgeons first insert a shunt to drain fluid and relieve the pressure, after which they perform an open procedure called a craniotomy: a small access window is cut into the bony skull and the tumor surgically removed after which the window is closed again.
We also see many tumors within the ventricular areas, near the center of the brain. Craniotomies remain the conventional care for these tumors as well but open surgery in this instance poses a very high risk because so many sensitive areas must be traversed to get to the deep-seated tumor.
CCMC is one of the few pediatric hospitals in the country with the expertise and the intraoperative imaging capabilities to remove these midline tumors endoscopically. Approaching the tumor often through the natural corridor of the nose and nasal sinuses, our surgeons skillfully thread their way to the midline tumor, disturbing little or no brain tissue en route, to resect the tumor with less trauma, resulting in a faster recover time. Baring complications, many children go home the same day or next day with no discomfort.
Other Treatment Options
Other modalities we employ include radiation and chemotherapy. Our radiation oncology team has vast experience in the use of intensity-modulated radiotherapy (IMRT), an advanced and still novel version of stereotactic radiosurgery in which a cancer-killing radiation beam is sharply focused on any remaining cancer cells while sparing surrounding healthy tissue from toxic exposure. Radiation therapies are generally not used in children under three.
Chemotherapy, which is directly supervised by our pediatric neuro-oncologists, includes systemic and targeted attacks on residual tumor cells that surgery and radiation may have missed. One of the targeted attacks employs tiny biodegradable gliadal wafers impregnated with a cancer-destroying agent that we implant in the spaces vacated by resected tumors. Other chemotherapeutic drugs are taken by mouth, by injection or intravenous line, both in and out of the hospital.
Contract our Program Coordinator with your questions.
Alyssa Quinnlan, PA
The Brain Tumor Program: Advanced Care, Compassionate Environment