Childhood Ependymoma: Treatment

by National Cancer Institute

(Page 2 of 2)

Your child's treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

• Neurosurgeon.
• Neurologist.
• Neuropathologist.
• Neuroradiologist.
• Rehabilitation specialist.
• Radiation oncologist.
• Medical oncologist.
• Endocrinologist.
• Psychologist.

Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments.

Three types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood ependymoma as described in the General Information 5 section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Certain ways of giving radiation therapy can help keep radiation away from healthy tissue:

• Conformal radiation therapy uses a computer to create a 3-D picture of the tumor. The radiation beams are shaped to fit the tumor.

• Stereotactic radiation therapy uses a head frame attached to the skull to aim radiation beams directly at the tumor.

Radiation therapy to the brain can affect growth and development in young children and is not standard treatment for children younger than 3 years. For this reason, conformal radiation therapy that limits damage to healthy brain tissue is being studied in infants and children with ependymoma.

Damage to the brain in young children treated for ependymoma is not always due to the effects of radiation therapy. For example, when hydrocephalus (abnormal buildup of fluid in the brain) is found at diagnosis, it is linked with lower intelligence test scores following surgery and before radiation therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Treatment Options for Childhood Ependymoma

Newly Diagnosed Childhood Ependymoma

Newly diagnosed childhood ependymoma is a tumor that has not been treated. The patient may have received drugs or treatment, however, to relieve symptoms caused by the tumor.

Initial treatment for newly diagnosed childhood ependymoma is usually surgery, with or without additional treatment.

After surgery, treatment depends on the age of the child, the amount of tumor that was removed, and whether cancer cells have spread to other parts of the central nervous system.

When the tumor is completely removed by surgery and cancer cells have not spread within the central nervous system, treatment may include the following:

• Radiation therapy to the tumor bed (where the tumor was before it was removed), for children aged 3 years or older.
• A clinical trial of watchful waiting, for children aged 1 year or older.
• A clinical trial of conformal radiation therapy.
• A clinical trial of chemotherapy with or without radiation therapy.

When a part of the tumor remains after surgery, but cancer cells have not spread within the central nervous system, treatment may include the following:

• Second-look surgery.
• Radiation therapy to the tumor bed, for children aged 3 years or older.
• A clinical trial of chemotherapy followed by second-look surgery and conformal radiation therapy, for children aged 1 year or older.

When cancer cells have spread within the central nervous system, treatment may include the following:

• Radiation therapy to the whole brain and spine.
• A clinical trial of radiation therapy and chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Recurrent Childhood Ependymoma

Standard treatment of recurrent childhood ependymomas may include the following:

• Surgery.
• Radiation therapy, including stereotactic radiation therapy with or without chemotherapy.
• Chemotherapy with or without radiation therapy.

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