Tumors of the central nervous system (CNS) are malignant or benign neoplasms that can develop in the brain or spinal cord. CNS tumors are the second most common group of oncological diseases in children after leukemia. The most common types of CNS tumors in children include medulloblastoma, glioma, astrocytoma, ependymoma, and craniopharyngioma. Treatment depends on the tumor type, location, size, the child’s age, and overall health status.
Treatment of CNS tumors in children requires a multidisciplinary approach involving neurosurgeons, oncologists, radiologists, neurologists, and rehabilitation specialists.
Main treatment methods for pediatric CNS tumors in Belarus
- Surgical removal. Surgery is the primary treatment for most CNS tumors. The goal is to remove as much of the tumor as possible while preserving vital brain structures. In some cases (for example, low-grade astrocytomas), surgery alone may be sufficient. In other cases (such as medulloblastoma), surgery is combined with chemotherapy and/or radiation therapy. When complete removal is not possible due to tumor location, maximal safe resection is performed.
- Radiation therapy. Radiation therapy is used to destroy residual tumor cells after surgery or to treat tumors that cannot be surgically removed. It may involve irradiation of the entire brain and spinal cord (craniospinal irradiation) or be limited to the tumor site. In very young children (under 3–5 years), radiation therapy is avoided when possible due to potential effects on cognitive and physical development; chemotherapy is preferred instead.
- Chemotherapy. Chemotherapy is used to destroy tumor cells and inhibit their growth. It may be administered before or after surgery, or as an alternative to radiation therapy in young children. Drugs are given intravenously and often include combinations such as vincristine, carboplatin, cisplatin, and etoposide. Treatment is delivered in cycles with recovery periods.
- Targeted therapy and immunotherapy. In selected cases, when tumors have specific molecular targets, targeted therapy may be prescribed to act on particular genes or proteins. Immunotherapy and novel approaches, including cancer vaccines, are being studied in clinical trials and may be used for complex or recurrent tumors.
Treatment by type of CNS tumor
- Medulloblastoma. A malignant tumor most commonly arising in the cerebellum. Treatment includes surgical removal, craniospinal radiation therapy, and chemotherapy. Prognosis depends on tumor spread and molecular characteristics. Advances in therapy have significantly improved survival rates.
- Low-grade gliomas (astrocytomas). These tumors may be benign and treatable with surgery alone. If complete resection is achieved, additional therapy may not be required. For tumors located in difficult areas (such as the optic pathway or brainstem), chemotherapy or targeted therapy is used.
- High-grade gliomas. Anaplastic astrocytoma and glioblastoma require aggressive treatment, including surgery (if feasible), chemotherapy, and radiation therapy. Prognosis depends on tumor aggressiveness and treatment response.
- Ependymoma. Treatment begins with surgical removal. Complete resection is critical for improving outcomes. Radiation therapy is usually administered postoperatively, while chemotherapy is reserved for selected or complex cases.
- Craniopharyngioma. A benign tumor often affecting the pituitary and hypothalamic region. Treatment involves surgical removal, with radiation therapy used in some cases to control residual tumor growth.
Prevention of recurrence and long-term follow-up
- Regular monitoring. After treatment, children require regular MRI scans and follow-up examinations to detect recurrence at an early stage.
- Hormone replacement therapy. If treatment affects the pituitary gland, lifelong hormone replacement therapy may be necessary to support normal growth and development.
- Monitoring cognitive function. Psychologists and neurologists assess cognitive development and provide educational and psychological support when needed.
Treatment of CNS tumors in children requires a comprehensive approach that includes surgery, chemotherapy, radiation therapy, and rehabilitation. Each tumor is unique, and therapy must be individualized to minimize side effects and improve quality of life. Early diagnosis and the use of modern treatment strategies give children a real chance for recovery and return to normal life. Family support, rehabilitation, and regular medical follow-up play a crucial role in long-term outcomes.
