Brain tumors in children

Mathilde Regnault
05/26/2017
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Brain tumors are the most common solid tumors in children, with 500 new cases each year in France in the under-18 age group. This term actually covers a range of very different tumors, for which the treatment and prognosis differ.
Les tumeurs cérébrales de l’enfant
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What are brain tumors?

Brain tumors in children can occur at any age, from infancy to adolescence. There are three main types of tumor, which cover most cases.

Glial tumors These are the most common, regardless of the location. They comprise diseases with very varied prognoses (good prognoses for low-grade tumors, guarded prognoses for high-grade tumors).

Embryonal tumors These account for more than 20% of brain tumors, including medulloblastomas, located in the cerebellum, and atypical teratoid/rhabdoid tumors (AT/RT).

Ependymomas These account for fewer than 10% of brain tumors.

Other brain tumors include intracranial germ-cell tumors and craniopharyngiomas.

The symptoms caused by the tumor are often difficult to recognize. They are often initially connected to intracranial high blood pressure, caused by the tumor. This may lead to headaches, vomiting, strabismus and sleep, mood or learning disorders. The neurological signs are not constant and depend upon the location of the tumor; symptoms include problems with mobility, vision, speech, swallowing and balance. In young children, the symptoms can also include loss of psychomotor skills or an increase in head circumference.

The test used to confirm the diagnosis is an MRI, followed, whenever possible, by a surgical test to excise the tumor or to take a sample (biopsy) for analysis. Some rare tumors (secreting germ-cell tumors, for example) may be diagnosed by testing the markers in the blood or the cerebrospinal fluid. Progress in recent years has helped to better characterize the tumors in terms of biopathology, which aids in adapting treatments.

Standard treatment for brain tumors in children uses the three main therapeutic weapons in cancer treatment.

Surgery As far as possible and depending on the location, this involves removing all or part of the tumor.

Radiotherapy is also commonly employed to treat brain tumors in children, using techniques that spare healthy tissue as much as possible.

Anti-tumor medication is also often a major element of treatment.

The prognosis for brain tumors in children is extremely variable, depending on the type of tumor and its stage of development. After-effects of the illness and treatment are a major issue for physicians and researchers. Current research aims not only to improve the prognosis, but also to limit side effects of the illness and treatment as much as possible, as these affect the developing nervous system.

 

Treatment for this type of cancer at Institut Curie 

Institut Curie is an expert center for brain tumors in children. The treatment protocol is decided upon as part of multidisciplinary consultation meetings, where the various specialists (oncologist, radiotherapist, neurosurgeon, neuroradiologist, neuropathologist) pool their expertise.

Surgery is most frequently carried out at one of Institut Curie’s partner institutions ((Hôpital Necker Enfants Malades, Rothschild Foundation), whereas the rest of the treatment can be carried out at Institut Curie and partly delegated, when possible, to a center close to the child’s home.

Institut Curie has state-of-the-art technical equipment, and one of only two proton therapy platforms in France. Its experts can administer radiation to children under anesthesia.

Children treated at Institut Curie also enjoy a tailored environment at the PODAYA, where all efforts are made to maintain as normal a life as possible, with input from teachers, facilitators and a variety of associations. Children suffering from brain tumors are also monitored during physical medicine and rehabilitation or in neuro-pediatric units to assess and monitor the consequences of the disease and treatment on psychomotor and cognitive development, and to optimize the child’s academic and social integration.

 

Clinical and laboratory research on brain tumors in children

Although they are the most frequent solid tumors, brain tumors in children remain rare. Their increasingly precise biopathological characterization leads to a growing number of small, homogeneous groups of patients. In order to study these diseases and develop suitable treatments, physicians and researchers must work together on a European and even worldwide scale. These studies are often conducted at the SIOPE or the European consortium ITCC , in which Institut Curie plays a very active part. Several clinical trials are thus available at Institut Curie, including the PNET5 MB trial on medulloblastoma.

 

Various teams at the Institut Curie Research Center are working on brain tumors.

A research program, financed through public generosity and managed by Celio Pouponnot, was launched in 2016. The goal is to find ways to better use radiotherapy in children.

The team of Dr. Schleiermacher and Dr. Bourdeaut is working on rhabdoid tumors

Olivier Ayrault’s team is studying medulloblastoma

In the Somatic Genetics unit, Gaëlle Pierron’s team is a leading laboratory for molecular characterization of embryonal tumors.

 

CLIP2: the recognition of trust

In 2015, Institut Curie received CLIP2 (Centre labellisé d’essais précoces, or certified early clinical trial center) certification from INCA.  “These centers receive logistical and financial support from the Institut to help them achieve the highest international level of quality in early-phase clinical trials,” explains the Institut national du cancer. Only six centers have received this certification for pediatric trials.
Find out more about CLIP2 certification.

 

Spécialistes référents
Département d’Oncologie pédiatrique