Pediatric Neuro-Oncology Multidisciplinary Program

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Definition

As with adults, brain tumors in children result from the uncontrolled growth of a population of cells within or adjacent to the brain.  Most brain tumors in children originate within the brain and are not the result of malignant cells spreading to the brain from another location in the body.  Additionally, pediatric tumors of the brain only rarely spread outside the brain and spinal cord.

Over 4,000 children in the United States are diagnosed with a brain tumor each year.  Brain tumors are the most common type of solid tumor and the second most common type of cancer (after leukemia) in children.

Symptoms

Because brain tumors can originate in any part of the brain, initial symptoms can be quite varied.  In children, the most common symptoms are headache, nausea, vomiting, sleepiness, and irritability. Less common signs and symptoms include seizures and weakness. 

Evaluation

Brain tumor diagnosis may begin with a visit to a pediatrician, neurologist, or emergency department. The physician reviews the history, does a thorough neurological exam, reviews imaging tests and orders any additional testing.

Imaging tests may include:

• Computerized tomography (CT) scan. A CT scan uses a sophisticated X-ray machine linked to a computer to produce detailed, two-dimensional images of the brain. CT scans are both quick and widely available. As a result, they are often the first imaging test that a patient with a brain tumor will receive. A CT scan can be very helpful in the diagnosis of many types of tumors, and is the best imaging test to evaluate bone and possible calcium deposits that are present in some tumors. CT, however, does not offer the high degree of resolution of brain tissue that is obtained with an MRI.
  
• Magnetic resonance imaging (MRI) scan. MRI is a technique that uses a magnetic field and radio waves to create detailed images of the brain. It is a rapidly growing field of radiology that can increasingly examine both structure and function.  In the context of a brain tumor, functional MRI scans are occasionally employed to identify critical brain areas involved in speech and motor activity.
  
• Other brain scans. Other tests — such as magnetic resonance spectroscopy (MRS), single-photon emission computed tomography (SPECT) or positron emission tomography (PET) scanning — help doctors gauge brain tumor activity and blood flow. 
  
• Angiogram.  This test involves the positioning of a small catheter through an artery in the leg into an artery in the neck. A special dye is then injected into the arteries that supply the brain, allowing the blood vessels to be very precisely seen using X-ray. Although this test is not often required for children with brain tumors, it is the most accurate test to define blood vessel anatomy. 
  

Biopsy

A biopsy involves removing a piece of the tumor in order to obtain a diagnosis and make the most appropriate treatment plan.  Based on the characteristics of the patient, CU neurosurgeons may recommend a small biopsy, in which a needle is used to remove a specimen, or a more complete resection of the tumor.

When the specimen is removed, a doctor who specializes in examining brain and nervous system tumors (neuropathologist) examines the tissue immediately, often providing a preliminary diagnosis before surgery is completed.  A thorough pathological examination of the tissue is critical for an accurate diagnosis, and a complete evaluation usually requires 5-7 days. Our neuropathologists are internationally known for their expertise in diagnosing brain tumors.

Treatment Options

CU Neurosurgery at Children’s Hospital Colorado is part of a multidisciplinary team of experienced specialists who work together to diagnose and treat children with brain tumors throughout the Rocky Mountain region.  All children with a newly diagnosed brain or spinal cord tumor are presented and discussed at a multidisciplinary tumor board meeting to determine the best treatment plan.  This meeting includes neurosurgeons, neuro-oncologists, neuropathologists, radiation oncologists, neuro-psychologists, and neuroradiologists.  The overall long-term quality of life is the most important consideration in our treatment approach.

For every child, the treatment plan is tailored to the needs of the patient and family. Aside from surgery, most brain tumor care is delivered on an outpatient basis. Whenever possible, our specialists work with local doctors to administer therapy closer to home if you live a long distance from the hospital.

A Team Approach

During your child’s treatment, you are likely to meet several specialists from the brain tumor treatment team. These may include:

• Neuro-Oncology.  The neuro-oncology team consists of physicians, nurse practitioners, social workers, and nutritionists. This group coordinates and facilitates the care of each patient. 
  
• Neurosurgery. CU Neurosurgery’s pediatric neurosurgeons are highly experienced, performing over 750 surgeries each year. They are experienced in the use the advanced surgical technologies, such as stereotactic guidance, endoscopic neurosurgery, awake surgery and the use of intraoperative lasers for tumor ablation.
  
• Radiation oncology. Radiation oncologists use high-energy X-rays, electron beams or radioactive isotopes to kill cancer cells. Radiation oncologists at Children’s Hospital Colorado are the only radiation oncologists in the region who specialize in treating children.  They are an integral part of the neuro-oncology team.  
  
• Neuropathology. Accurate diagnosis is of paramount importance in the appropriate treatment of pediatric brain and spine tumors. CU Neurosurgery’s pathologists are world renowned for their diagnostic skill. 
  
• Neuroradiology. Pediatric neuroradiologists specialize in the imaging of the pediatric brain and spine. Children’s Hospital Colorado neuroradiology reviews the imaging of every child who is cared for by the neuro-oncology program.  They work intimately with CU neurosurgeons at Children’s. 
  
• Other services. We offer access to other services, including supportive care, counseling, neurocognitive and neuropsychiatric services, brain rehabilitation and pain management whenever needed.
  

Follow-up

When the period of their active treatment is complete, every child who is taken care of by the neuro-oncology program at Children’s Hospital Colorado is followed in our multi-disciplinary long term follow-up clinic.  This allows each child to be seen by multiple specialists at one visit.  The frequency of follow-up is determined by each child’s specific needs.

Research & Clinical Trials

Both CU neurosurgeons at Children’s and the Neuro-oncology group are actively involved in multiple areas of research and clinical trials.  Over 500 children with brain tumors have been treated by the Neuro-Oncology Program since its inception in 1995. The region covered by the program has gradually increased and now covers Colorado, New Mexico, Montana, Wyoming, much of Nebraska and western Kansas. The program is a fully participating member of the Children’s Oncology Group.

The Experimental Therapeutics Program (ETP) at The Children’s Hospital Center for Cancer and Blood Disorders is committed to serving those patients with recurrent illness, those whose disease has been refractory to traditional treatment and those with a diagnosis that has no reasonable curative prospect. The medical staff of ETP offers children, adolescents and young adults access to Phase I trials and First-in-Pediatrics protocols that are available at a very limited number of institutions.  As a member of the Pediatric Oncology Experimental Therapeutics Investigators Consortium (P.O.E.T.I.C.), The Children’s Hospital ETP program is one of nine centers in the United States and Canada that can offer certain experimental therapies to patients with relapsed or refractory disease. The specific protocols open at any one time vary and eligibility criteria are strict. The Children’s Hospital ETP physicians and personnel have worked with patients from 23 states and many foreign countries. 

The Neuro-Oncology Program is also the lead institution in the Children’s Neuro-Oncology Consortium which covers eight major programs in the United States and develops innovative therapy for children with poor prognosis brain tumors.  Dr. Nicholas Foreman is the chair of the subcommittee for ependymomas for the Children’s Oncology Group, leading all ependymoma protocols and their development in the United States.  The group has recognized and published expertise in high dose therapy particularly for young infants. The program has published over 50 articles in peer reviewed journals. The Neuro-Oncology laboratory concentrates on the development of novel therapies for glial tumors, such as astrocytoma, ependymoma, and glioblastoma.  Drs. Handler, Hankinson and Foreman have recently been actively involved in promoting a more active diagnostic approach for children with Diffuse Pontine Gliomas.