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Pediatric Brain Tumors

Treating Brain Tumors in Children

Dr. Sandberg is affiliated with Memorial Hermann Health System. Views or opinions presented in this video are solely those of the physician(s) or presenter(s) and do not necessarily represent the views and opinions of Memorial Hermann Health System. This video is presented to the public for educational purposes only and Memorial Hermann Health System is not responsible for its content. Patients should consult a physician regarding the diagnosis and treatment of any medical condition.

What are the symptoms of a tumor in the brain?

Tumors of the central nervous system constitute the second most common cancer of childhood. Tumors can occur in any portion of the brain and can be benign or malignant. If the tumor develops in the brain, children usually develop headache, rapid head growth (in infants), and nausea with or without vomiting.

How is a tumor in the brain evaluated?

When a tumor is suspected, the first step is neuroimaging. Usually MRI scanning with and without a contrast agent is the preferred study. The contrast agent is a drug given intravenously which can provide additional detail of the tumor and surrounding nervous system structures. Once the MRI is completed, treatment decisions are made. Usually a surgical biopsy or resection is performed. Pathologic evaluation of the tumor directs subsequent treatment choices, which include chemotherapy and/or radiation therapy.

What is the surgical treatment of a tumor in the brain?

For most pediatric brain tumors, the extent of tumor resection is critical. A greater than 90% removal correlates with improved long-term survival. To enhance the safety of tumor resection, functional mapping techniques are utilized. These include magnetoencephalography (MEG) and intraoperative corticography. Both techniques can identify areas of brain critical to motor, sensation, and speech, so that these can be avoided during tumor resection. In addition, image guided systems allow computer guided resection of tumors.

What happens after surgery for a tumor in the brain?

Treatment following surgery is directed by the pathologic diagnosis, the location of the tumor, and the extent of resection. The care is conducted by a multidisciplinary team consisting of a neurooncologist, radiation oncologist, neurologist, and neurosurgeon. Treatment may be as simple as observing the tumor with serial MRI scans or as complicated as chemotherapy with radiation therapy. Coordinated care and long term surveillance should be part of every patient's care.

About the brain tumor program.

Pediatric Brain Tumor Trials

Infusion of 5-AZA Pilot Study

The Children’s Neuroscience Center has a new brain tumor trial that is open to qualified participants. The research study is being conducted by David Sandberg, M.D., Professor and Director of Pediatric Neurosurgery at McGovern Medical School at UTHealth and Children’s Memorial Hermann Hospital.

The study is called “Infusion of 5-Azacytidine (5-AZA) into the Fourth Ventricle or Resection Cavity in Children with Recurrent Posterior Fossa Ependymoma: A Pilot Study.” It is open to patients who are age 1 to 21 years old with recurrent ependymoma that originated in the posterior fossa of the brain.

The study employs a novel means of treating ependymoma brain tumors that originate from the fourth ventricle: infusion of a chemotherapy agent directly into the fourth ventricle rather than systemic intravenous delivery. The agent being infused, 5-AZA, has never been infused into the brain in humans but has been shown to effectively kill ependymoma cells in the laboratory. There will be no simultaneous systemic chemotherapy.

This study is listed at ClinicalTrials.gov, NCT # 02940483, under “Brain Tumor Recurrent.” If you would like additional information about this study, please contact Bangning Yu, M.D., Ph.D., by email at Bangning.Yu@uth.tmc.edu or call (713) 500-7363.

Combination Intraventricular Chemotherapy Pilot Study

The Children’s Neuroscience Center has a new brain tumor trial that is open to qualified participants. The research study is being conducted by David Sandberg, M.D., Professor and Director of Pediatric Neurosurgery at McGovern Medical School at UTHealth and Children’s Memorial Hermann Hospital. The study is called “Combination Intraventricular Chemotherapy Pilot Study: Methotrexate and Etoposide Infusions into the Fourth Ventricle or Resection Cavity in Children with Recurrent Posterior Fossa Brain Tumors.” It is open to patients who are age 1 to 21 years old with recurrent medulloblastoma (PNET), recurrent ependymoma, and recurrent atypical teratoid/rhabdoid tumors involving the brain and/or spine.

The study employs a novel means of treating malignant tumors that originate from the fourth ventricle: infusion of two chemotherapy agents directly into the fourth ventricle rather than systemic intravenous delivery. There will be no simultaneous systemic chemotherapy. This study is listed at ClinicalTrials.gov, NCT # 02905110, under “Brain Tumor Recurrent.” If you would like additional information about this study, please contact Bangning Yu, M.D., Ph.D., by email at Bangning.Yu@uth.tmc.edu or call (713) 500-7363.

Phase I Dose-Escalation Trial

A phase I dose-escalation trial is now open to qualified participants at Children’s Memorial Hermann Hospital. The trial is the only study in the world investigating the direct administration of methotrexate into the fourth ventricle of the brain for the treatment of children with recurrent malignant fourth ventricular brain tumors.

The clinical trial is led by David Sandberg, M.D., FAANS, FACS, FAAP, director of pediatric neurosurgery at Children’s Memorial Hermann Hospital, the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center, and the McGovern Medical School at UTHealth. Dr. Sandberg has pioneered the use of direct infusions into the fourth ventricle of the brain to treat children with recurrent malignant brain tumors in this location. A pilot clinical trial completed in August 2015 demonstrated that some patients with recurrent medulloblastoma experience a beneficial anti-tumor effect both within the fourth ventricle and at distant sites.

Delivering chemotherapeutic agents directly to the site of disease is particularly advantageous for children because it enables high drug concentrations at the site of disease origin while minimizing the side effects of chemotherapy by decreasing systemic drug exposure. To learn more about the trial, please contact Bangning Yu, M.D., Ph.D., by email at Bangning.Yu@uth.tmc.edu or call (713) 500-7363.

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This information, although based on a thorough knowledge and careful review of current medical literature, is the opinion of doctors at The University of Texas Medical School and is presented to inform you about surgical conditions. It is not meant to contradict any information you may receive from your personal physician and should not be used to make decisions about surgical treatment. If you have any questions about the information above or your child's care, please contact our doctors.