Pediatric Brain Tumors Facts

• Paediatric brain tumours are the most common solid tumour in children, but this is largely due to the high number of low‑grade gliomas. High‑grade tumours such as glioblastoma and diffuse midline glioma are far less common, though significantly more aggressive.
• Among all childhood cancers, brain tumours are the leading cause of death.
• Despite advances in medical knowledge, there is no direct cause for brain tumors identified. A combination of genetic and environmental factors is blamed to come into play in the pathogenesis of brain tumours. Multiple known cancer predisposition syndromes show associations with brain tumours, for example, DICER1, Li-Fraumeni, and other neurocutaneous syndromes such as neurofibromatosis, tuberous sclerosis, and Von-Hippel Lindau.
• Family history may play a role in the aetiology as many studies report an association of brain tumours and siblings, although this occurrence is rare.
• Several studies have suggested a link between infectious exposure during childhood and brain cancer, but this topic remains debatable.
• High dose radiation has been linked to brain malignancies. Children who have received radiation for leukemia are known to be at risk for developing brain cancer.
• The principal treatment for brain tumours is surgery aiming for gross total resection. The extent of the brain tumours and the general condition of the patient are important determinants of surgical outcome. Adjuvant therapies are not commonly used in neonates. Craniospinal radiotherapy results in significant developmental retardation and is avoided during the first 3 years of life.
• Congenital brain tumours have a poor prognosis with overall survival of less than 30%.Several factors such as malignant histological type, size, and location of the tumour, stage of foetal development, and treatment-related complications play a significant role in survival outcomes.
• Early detection of brain tumours and prompt referral to paediatric neurosurgery and paediatric neuro-oncology teams is vital. This usually starts with the paediatrician, nurse practitioner, family physician or emergency physician. The optimum care of patients with brain tumours occurs through an interprofessional collaboration including oncology, diagnostic imaging, pathology, radiotherapy, nursing, rehabilitation, and social workers.

Moving forward

• There are many studies using therapies that can boost the immune system in recognising and killing the cancer cells. All those therapies are currently in a experimental stage and more research is needed.  
• Children who survive treatment via surgical removal develop neurological consequences from said surgery. More studies are necessary to understand the impact that different treatment options, tumour pathology, and tumour location have on neurological outcome.
• Brain tumours in children are challenging to treat surgically. 
• This is a problem as there is no satisfactory brain maps for children, unlike the many brain maps that exist for adults.
• There are new resources being developed in Australia that will make the highest resolution brain maps of the child, natively obtained from child MRI scans. Such a resource will, when complete assist in surgical treatment of children’s brain cancer.