Chemotherapy, or chemo, has been around since the days of the ancient Greeks. However, chemotherapy for the treatment of cancer began in the 1940s. Since then, many new drugs have been developed and tried and most recently due to technological advances there have been a proliferation of new, targeted chemo therapies developed for many different forms of cancer.
Unfortunately for the pediatric brain tumor community, there has been little advancement (or even investigations) in the arena of targeted chemo for children battling the most common forms of brain tumors. While chemo is NOT a cure, at times, it can be used to help arrest brain tumor growth.
The following represents the most commonly asked questions about chemo and children’s brain tumors.
1) The word 'chemotherapy' is most often associated with cancer. But for children battling Grade 1 and Grade 2 tumors or ‘benign’ tumors, many doctors do not call this cancer. So, why are these children getting chemotherapy?
Chemotherapy is drug treatment designed to stop the division of abnormal cells. In other parts of the body a non-cancerous tumor may be able to be completely removed. The problem in the brain is that some benign tumors can not be completely removed which allows those abnormal cells left to regrow. Thus, chemotherapy and radiation may be treatments for children with brain tumors.
2) How does chemotherapy work?
Chemotherapy drugs destroy cancer cells by keeping the cells from further multiplying (interfering with mitosis) causing cell death. For example, vincristine disrupts the tubulin dimers which affect the mitotic spindles so that the chromosomes can not be pulled apart in cell division. Other chemotherapy agents affect the cells DNA. Unfortunately, chemotherapy can affect all rapidly dividing cells so that healthy cells can also be affected. Hair loss and low blood counts are common affects on normal cells when chemotherapy is given.
3) How well does chemotherapy work for slower growing brain tumors?
There are cases where slow growing brain tumors have seen significant regression, however, this tends to happen slowly. With the most common forms of children’s brain tumors, often stability is the primary goal of chemotherapy.
4) If chemotherapy often only has a stability effect, why do we use it?
Chemotherapy is often used as a first line therapy because it can help arrest the growth of the tumor without exposing the child to radiation and its long-term effects. Radiation not only includes the tumor site but also has some spill over to normal tissue. Depending on where the tumor is located within the brain, a wide variety of problems can occur with radiation (such as issues with learning and endocrine function.) Often the hope is to make the tumor ‘quiet’ with chemo and if/when the brain tumor regrows, the child will be older and more able to handle the late effects of radiation.
5) What is a chemotherapy protocol?
A chemotherapy protocol is the way a drug or combination of drugs are prescribed. In general, chemotherapy treatment is given in cycles. This allows the cancer cells to be attacked at their most vulnerable times, and allows the body’s normal cells time to recover from the damage. There are really three issues regarding the cycle: amount of drug, cycle interval, and how many cycles. All of these variables are discussed with various medical experts and a chemo strategy is developed. New protocols in clinical trials have a clinical trial number and parents should be able to see a summary or roadmap of the trial.
6) When is chemotherapy indicated as a treatment option for kids battling brain tumors?
Again, there is no ONE answer to this question. Most often, doctors recommend use of chemo when total surgical resection has NOT been possible (usually due to the sensitive location of the tumor within the brain) or a previously resected tumor returned. It is possible that a doctor will recommend watch-and-wait with regular MRIs, with a partially resected tumor, before starting chemotherapy. There have been some cases of spontaneous regression with partial resections.
7) What are the standard chemotherapy drugs used for children with brain tumors?
While there is no ONE right answer to this question, there are several different options that are typically at the front line for chemo treatments in kids with brain tumors.
8) How is chemotherapy administered?
Most often chemotherapy is given intravenously. Many children battling brain tumors will have ports or lines (such as a Hickman or Broviac) placed in the chest wall which makes access to administer treatment easier. Many of the protocols are given as an outpatient, where the child comes into the clinic only. Some agents can also be administered orally, like temozolomide.
9) If a child starts on one chemotherapy and it doesn't work, can another one be given?
Yes. Many of the children with brain tumors are on several different chemo agents over time.
A family offers a video clip of their child’s journey through a chemo clinical visit, as a resource for families. “Helping Hailey Through Regular Chemotherapy Visits at the Hospital”
New advancements in chemotherapy for children with brain tumors is greatly needed as current treatments are ineffective and cause unwanted gross motor and neurological deficits.
Jump starting targeted pediatric brain tumor research is exactly what A Kids’ Brain Tumor Cure Foundation is all about.
Unite to fight by donating A Kids’ Brain Tumor Cure Foundation…and help build a brighter future for children around the world battling brain tumors.