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Childhood brain tumors: epidemiology, current management and future directions

Nature Reviews Neurology volume 7, pages 495–506 (2011)Cite this article

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Abstract

Brain tumors are the most common solid tumors in children. With the increasingly widespread availability of MRI, the incidence of childhood brain tumors seemed to rise in the 1980s, but has subsequently remained relatively stable. However, management of brain tumors in children has evolved substantially during this time, reflecting refinements in classification of tumors, delineation of risk groups within histological subsets of tumors, and incorporation of molecular techniques to further define tumor subgroups. Although considerable progress has been made in the outcomes of certain tumors, prognosis in other childhood brain tumor types is poor. Among the tumor groups with more-favorable outcomes, attention has been focused on reducing long-term morbidity without sacrificing survival rates. Studies for high-risk groups have examined the use of intensive therapy or novel, molecularly targeted approaches to improve disease control rates. In addition to reviewing the literature and providing an overview of the complexities in diagnosing childhood brain tumors, we will discuss advances in the treatment and categorization of several tumor types in which progress has been most apparent, as well as those in which improvements have been lacking. The latest insights from molecular correlative studies that hold potential for future refinements in therapy will also be discussed.

Key Points

  • The mode of clinical presentation for childhood brain tumors is influenced by patient age, tumor location, and tumor histology

  • Advances in imaging techniques have led to improved detection of, and treatment planning for, childhood brain tumors

  • Extent of surgical resection affects prognosis for most childhood brain tumors, including glioma, medulloblastoma and ependymoma

  • For certain high-risk tumors, such as metastatic medulloblastomas, the addition of chemotherapy to surgery and irradiation has led to improvements in survival rates

  • For other tumor types, administration of chemotherapy has allowed delay in radiation administration or reduction or refinement of radiation delivery to minimize late sequelae of treatment

  • Insights regarding genomic alterations are refining the classification of several childhood brain tumor types (including medulloblastoma) and identifing novel molecularly based therapeutic targets

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Figure 1: Typical appearance and characteristics of a diffuse intrinsic pontine glioma.
Figure 2: Appearance of several types of low-grade gliomas on MRI.
Figure 3: Typical appearance of a medulloblastoma.
Figure 4: MRI appearance of a high-glade glioma.

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Acknowledgements

This work was supported in part by NIH grants P01NS40923 and R01NS37704 to I. F. Pollack. The authors appreciate the assistance of Dr A. Panigrahy, Children's Hospital of Pittsburgh, PA, USA, and Dr S. Bluml, Childrens Hospital Los Angeles, CA, USA, who provided the magnetic resonance spectroscopy images depicted in Figure 1c.

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  1. Departments of Neurosurgery and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, 15224, PA, USA

    Ian F. Pollack & Regina I. Jakacki

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  1. Ian F. Pollack
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I. F. Pollack researched data for the article. I. F. Pollack and R. I. Jakacki made equal contributions to discussions of the content. Both authors contributed to the writing, reviewing and editing of the manuscript, with I. F. Pollack doing the majority of the writing and editing and R. I. Jakacki doing the majority of the reviewing.

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Correspondence to Ian F. Pollack.

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Pollack, I., Jakacki, R. Childhood brain tumors: epidemiology, current management and future directions. Nat Rev Neurol 7, 495–506 (2011). https://doi.org/10.1038/nrneurol.2011.110

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