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In general, the successful treatment of tumors of the brain requires a multidisciplinary approach and, not infrequently, multiple treatment modalities. Each possible modality (surgery, chemotherapy, radiation therapy or observation) must be included in the considerations of how best to control the tumor and to prevent its regrowth.

Brain tumors, unlike tumors arising in other areas of the body, can have periods of quiescence. This is particularly true for slow-growing tumors. Some of these can even fluctuate in size, shrinking at times, growing at others. Consequently, it may be elected to watchfully wait or do nothing other than periodically perform MRI scans in children with tumors in the central nervous system. This may be chosen when a tumor is discovered by chance, when it is small or when it is causing no symptoms. This also may be chosen after a deep tumor has been partially resected, especially when dealing with a young child or when the tumor is fast growing.


Surgery is usually the first choice for treatment of pediatric brain tumors. The goals of surgery are to establish a tissue diagnosis, relieve raised pressure inside of the head (if present), and contribute to the overall treatment of the brain tumor. Surgery is the most rapid method of removing tumors. In some cases when the brain tumor is of a low grade (low growth potential), radical surgery may be the only treatment required. In contrast, in cases of rapidly growing brain tumors, radical surgery leaves less tissue behind and makes the job of consolidating control over the tumor by other treatments easier.

Post-operatively, some patients will require radiation and/or chemotherapy. In these individuals, the brain swelling that may occur during these treatments is better tolerated after radical surgery because of room provided by the surgery. Ultimately, the success of surgery depends upon the size, type and location of the tumor. Typically, a post-operative MRI scan is obtained. If the post-operative scan demonstrates a significant amount of residual tumor in the brain, a reoperation may be indicated depending on the patient's clinical status, the type of tumor and its location.

The Tumor Board

The "Tumor Board" is used by most cancer centers to discuss optimal treatment for a given individual. First, the neuropathologist renders a tissue diagnosis, and then appropriate tests are performed to see if there has been any spread of the tumor. Experts in the relevant disciplines then convene. Members of the Tumor Board may include neurosurgeons, neuroradiologists, neuropathologists, pediatricians, pediatric oncologists (specialists in the medical management of tumors in children), radiation oncologists (specialists in radiation therapy), nurse specialists and physiatrists (specialists in the rehabilitation of the nervous system).

The case history is presented, relevant radiographs are displayed, the surgery is described, and the pathology opinion is defended. The discussion is focused on the treatment options relevant to the patient's tumor type, stage (how extensive its growth has been) and risk category. Certain treatment options may be available through the institution's affiliation with a cooperative cancer group or through an institutional protocol (approved treatment plan). Other options may be available only in other institutions. Thereafter, one or two physicians will usually discuss the recommendations with the family. This discussion should include the risks and benefits of the key options. A team leader will often emerge who will take the long-term responsibility for coordinating the child's care. After this discussion, the family may wish to obtain a second opinion.

Treatment of Regrowth of Tumor

Under these circumstances, experimental treatment protocols are usually employed. Several options may be available at any one time, making selection difficult. We feel it is best, in this setting, to consult a treatment specialist who is participating in national or international study groups such as the Children's Oncology Group. Such individuals will typically be up to date on what studies are available and which are most appropriate for the situation at hand.