Brain tumour recurrenceBBrain tumour recurrenceBrain tumour recurrenceEnglishNeurologyChild (0-12 years);Teen (13-18 years)Brain;SpineNervous systemNAAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPCUri Tabori, MD00Flat ContentHealth A-Z<p>An in-depth description of signs and symptoms of a brain tumour recurrence, and steps that are taken in the event of a recurrence.</p><p>In some cases, even when a child has received the best of care, the tumour doesn't respond to treatment or only responds temporarily and then grows again. This is also known as progression or relapse. </p> <p>If your child has a recurrence, a new treatment plan will need to be considered. The plan will depend on a variety of factors:</p> <ul> <li> the type of tumour</li> <li> the physical condition of your child</li> <li> what the previous treatment was</li></ul><h2>Key points</h2> <ul><li>For recurrence, a new treatment plan will need to be considered based on tumour type, your child's physical condition, and previous treatment.</li> <li>Detection and treatment of recurrence depends on the type of tumour and the location.</li></ul>
Récurrence de la tumeur cérébraleRRécurrence de la tumeur cérébraleBrain tumour recurrenceFrenchNeurologyChild (0-12 years);Teen (13-18 years)Brain;SpineNervous systemNAAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPCUri Tabori, MD00Flat ContentHealth A-Z<p>Description approfondie des signes et des symptômes de récurrence d’une tumeur cérébrale et des mesures prises en cas de récurrence.</p><p>Dans certains cas, même si un enfant a reçu les meilleurs soins possibles, la tumeur ne répond pas au traitement ou n’y répond que temporairement pour ensuite revenir. C’est ce que l’on appelle aussi la progression ou la rechute. </p> <p>Si votre enfant présente une récurrence, il faudra envisager un nouveau plan de traitement. Le plan dépend d’une variété de facteurs :</p> <ul> <li>le type de tumeur;</li> <li>l’état physique de votre enfant;</li> <li>le traitement précédent.</li></ul><h2>À retenir</h2> <ul><li>Pour les récidives, il faudra envisager un nouveau plan de traitement fondé sur le type de tumeur, l’état physique de votre enfant et le traitement précédent.</li> <li>La détection et le traitement d’une récidive dépendent du type de tumeur et de sa localisation.</li></ul>

 

 

Brain tumour recurrence1385.00000000000Brain tumour recurrenceBrain tumour recurrenceBEnglishNeurologyChild (0-12 years);Teen (13-18 years)Brain;SpineNervous systemNAAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPCUri Tabori, MD00Flat ContentHealth A-Z<p>An in-depth description of signs and symptoms of a brain tumour recurrence, and steps that are taken in the event of a recurrence.</p><p>In some cases, even when a child has received the best of care, the tumour doesn't respond to treatment or only responds temporarily and then grows again. This is also known as progression or relapse. </p> <p>If your child has a recurrence, a new treatment plan will need to be considered. The plan will depend on a variety of factors:</p> <ul> <li> the type of tumour</li> <li> the physical condition of your child</li> <li> what the previous treatment was</li></ul><h2>Key points</h2> <ul><li>For recurrence, a new treatment plan will need to be considered based on tumour type, your child's physical condition, and previous treatment.</li> <li>Detection and treatment of recurrence depends on the type of tumour and the location.</li></ul><h2>If the tumour grows back</h2><p>Before any decision is made about treatment, some diagnostic tests may need to be repeated. The results will help your child’s neuro-oncologist decide how to proceed with treatment. These tests could include a lumbar puncture, MRI of the brain and spine, tumour markers, or bone marrow aspiration. </p><p>Unfortunately, for some tumours there is not much information at the moment on the best way to treat a recurrence successfully. Different hospitals may have different approaches. However, there are some general principles that are known for the three main types of treatment: </p><ul><li> Surgery is the treatment of choice for benign tumours that recur in the same area as the original tumour. Surgery is also used for malignant tumours that recur in the same area. If a tumour has spread or appears in more than one location, then surgery is not possible. </li><li> With some exceptions, radiation therapy is not generally given again to children a second time at the same location. If it is, usually it is given is to a different area of the body. </li><li> High-dose chemotherapy may be recommended. However, it is not yet known how many children will benefit. </li></ul><h2>How is recurrence detected?</h2><p>There are three ways that the tumour is detected when it grows back:</p><ul><li> If the tumour continues to grow or comes back during treatment, this is called refractory disease. This will be detected on regular scans, or on examination in the clinic. </li><li> After treatment, a child may start to have symptoms of the tumour again. This is called clinical or symptomatic recurrence. </li><li> After follow-up clinic visits, the tumour may be discovered during MRI scans even though the child doesn’t have any symptoms. This is called subclinical or asymptomatic recurrence. </li></ul><h2>Recurrence of low grade gliomas</h2><p>Surgery may be considered if a low grade glioma recurs in an area that can be operated on. It is often the only treatment needed for a cure. Sometimes though, the surgeon may not be able to remove the tumour completely and then you and your child's doctor will need to discuss options to best treat the remaining tumour. </p><p>If surgery is not possible, then other options are considered. Surgery may not be possible if the tumour is located in areas such as the brainstem, spinal cord, thalamus, optic nerve, or hypothalamus. </p><p>There are treatment protocols for recurrence that depend on the child’s previous treatment, and how the child responded.</p><p>Chemotherapy or radiation therapy will be considered. If a child has had radiotherapy before, then chemotherapy is given. If a child is younger, then chemotherapy is usually given and radiation therapy is delayed. </p><p>Radiation therapy will be considered if chemotherapy fails.</p><h2>Recurrence of optic and hypothalmic gliomas</h2><p>There are treatment protocols for recurrence that depend on the previous treatment, and how the child responded.</p><p>Chemotherapy, radiation therapy, or surgery will be considered. If the tumour is causing pressure on the brain, surgery may be done to remove some of the tumour. </p><p>If a child has had radiotherapy before, then chemotherapy is preferred. </p><p>If a child is younger, then chemotherapy is usually preferred and radiation therapy is delayed.</p><p>If the tumour has spread in the brain or to the spine, a biopsy will be done. If the new tumour looks similar to the original tumour, then the treatment of choice is usually chemotherapy. </p><p>Radiation therapy will be considered if chemotherapy fails.</p><h2>Recurrence of diffuse pontine gliomas</h2><p>Unfortunately, no chemotherapy or high-dose chemotherapy treatment has yet shown any benefit in curing a recurrence. When a diffuse pontine glioma recurs, the focus of care is to manage symptoms with the fewest side effects possible. Sometimes chemotherapy drugs taken by mouth are offered. Radiation therapy cannot be used at the same site as the initial tumour. </p><p>Surgery is sometimes considered when a recurrence occurs to place a shunt if the child has hydrocephalus. However, there is no clear evidence that a shunt extends a child’s life, or improves quality of life. </p><h2>Recurrence of high grade gliomas</h2><p>Unfortunately, despite intensive treatment, most high grade gliomas will recur. The time to recurrence is usually short, with most recurrences diagnosed within two years from the time of diagnosis. Recurrences are generally local, meaning that they occur at the same site as the original tumour. However, up to 30% of the children can present with dissemination (spreading of the tumour) at the time of recurrence.</p><p>Treatment at the time of recurrence depends on previous therapy:</p><ul><li> Infants: If there has been no previous radiation, a recurrence will be treated with surgery and radiation. </li><li> Older children: Surgery and chemotherapy is generally used.</li></ul><p>Several trials of chemotherapy are ongoing for children with recurrent high grade gliomas, however, their overall prognosis is guarded.</p><h2>Recurrence of ependymomas</h2><p>Surgery is the treatment of choice if an ependymoma recurs. It appears to offer the most benefit in improving the quality of life and the chance of success. </p><p>If radiation therapy was not done, then radiation at the site of the tumour is recommended. </p><p>If a child has had radiation therapy, re-irradiation may be considered. It involves giving one high dose of radiation and it often occurs after a repeat surgery. Depending on the type of recurrence, the doctor may choose to give a focal irradiation which focuses on the tumour itself, or craniospinal radiation which is given to the brain and spinal cord. </p><p>In some cases, radiosurgery may be considered. </p><p>The role of chemotherapy in treating a recurrent ependymoma is not clear. Many chemotherapy drugs are currently being studied, but no protocols have yet been developed that would improve results. Chemotherapy may be offered as an experimental treatment if the tumour can’t be removed by surgery, or if the tumour has spread (metastasized). </p><p>Overall, the results of treating a recurrence are better if the tumour is smaller and if it was detected in an MRI scan (subclinical recurrence). For that reason, a child with an ependymoma will have regular scans. </p><h2>Recurrence of medulloblastomas</h2><p>The treatment for a medulloblastoma recurrence is based on whether the child has had craniospinal radiation as part of initial treatment.</p><h3>Children who have had craniospinal radiation</h3><p>Extensive use of radiation therapy will not be part of treatment if a child has had craniospinal radiation therapy before. However, in some cases a child may be given a small boost of radiation. </p><p>Surgery may be recommended. Surgery may be possible if the tumour has grown back in the same area and it has not spread. </p><p>The decision to use chemotherapy depends on the previous chemotherapy treatment, and on the condition of the child. Some children may be too weak for intense chemotherapy. Treatment for a recurrence will usually involve different chemotherapy drugs. </p><p>There is also some evidence that high-dose chemotherapy with peripheral stem cell support may be helpful, but it is unknown how many children will benefit. </p><p>Several factors predict a child’s response to chemotherapy:</p><ul><li>Children whose recurrence is a long time from diagnosis tend to do better than children who relapse faster. </li><li>Children whose recurrence was detected in scans (subclinical recurrence), tend to do better than those whose recurrence was detected by symptoms (clinical recurrence). </li><li>Children with a single site of relapse will do better than those with multiple sites of relapse.</li></ul><p>If the tumour is responding to chemotherapy, then the goal will be to continue treating to try and achieve a cure. However, the overall cure rate with this approach is still less than 5%. </p><p>If the recurrence is not responding to chemotherapy, the treatment team will discuss whether the focus needs to shift. If it appears that nothing is working, then the goal may become to manage pain and symptoms through palliative care. </p><h3>Children who have not had craniospinal radiation</h3><p>Infants with medulloblastoma are usually treated with chemotherapy initially to delay or avoid the use of radiation therapy.</p><p>When recurrence occurs, it means chemotherapy has failed and radiation may need to be considered as an option. To reduce the potential damaging impact of radiation, focal or localized radiation may be used with high-dose chemotherapy and peripheral stem cell support. This strategy has shown some success only with recurrences that have not spread (non-disseminated recurrences). </p><h2>Recurrence of rhabdoid tumours</h2><p>The chance of recurrence of rhabdoid tumours is high, particularly if the child is less than three years old. Children in this age group tend to develop disease progression and/or recurrence with higher frequency and earlier in the course of therapy than older children. If their disease progresses, they are less likely to respond to additional therapy than older children.</p><p>The disease can recur in about half of children three years or older. Children in this age group with disease progression or recurrence may benefit from additional therapy with chemotherapy, with or without radiation. Younger children who did not receive radiation as part of their initial treatment may receive focal or craniospinal radiation in case of recurrence. However, the prognosis after recurrence is usually very poor.</p><p>If the disease is successfully treated and the tumour is removed, and there is no further recurrence after one year from treatment, the chance of the tumour returning is very low. If a child is still alive two years after treatment, his chances for long-term survival are very good.</p><h2>Recurrence of craniopharyngiomas</h2><p>There are different approaches to treating a recurrence of a craniopharyngioma. Because a craniopharyngioma may be made up of cysts and solid tumour, the recurrence can happen in either. The treatment will depend on the type of recurrence. </p><p>If the solid tissue grows back, either surgery or radiation may be used as treatment. In some cases, surgery and radiation may both be used. </p><p>If the cysts grow back, chemotherapy drugs may be delivered directly into the cyst by an internal catheter (tube). The drugs that are used are interferon, bleomycin or yttrium-90. This is called intracystic treatment. Sometimes two to three treatments with bleomycin or interferon are needed. </p><h2>Recurrence of germ cell tumours</h2><p>In general, non-germinatous germ cell tumours recur more quickly than germinomas. The time to recurrence of a germinoma ranges from 27 to 35 months while the time to recurrence of a non-germinatous germ cell tumour is about 11 months.</p><p>Children with a relapsed germ cell tumour who have previously received chemotherapy only can often be successfully treated with craniospinal radiation only. This is especially true with children who have a relapsed germinoma.</p><p>In children with a relapsed germ cell tumour who have previously received a combination of chemotherapy and radiation, the treatment is more uncertain. Giving them more radiation may lead to toxic side effects.</p><h2>Recurrence of other tumours types</h2><p>For other types of tumours that recur, talk to your child’s treatment team for information on the treatment plan.</p>Brain tumour recurrence

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