Astrocytoma in children

The main treatment for most astrocytomas is surgery to remove as much of the tumour as possible. But it isn't always possible to fully remove tumours in some areas of the brain.

For example, surgery to remove tumours in the brainstem can cause too much damage to the surrounding normal brain tissue.

Low grade tumours are generally easier to remove than high grade tumours. This is because they are less invasive. This means they don't spread out into the surrounding brain tissue in the way that some high grade tumours do.

Surgery might be the only treatment your child needs.

Hearing your child needs brain surgery can feel very frightening. A paediatric neurosurgeon does the operation. They are highly skilled professionals. They can help answer any questions you might have about the operation.

Find out more about surgery

Fluid build up

Some tumours whether they are low or high grade cause fluid to build up in the brain. This is called hydrocephalus. Treatment to reduce this is an operation. Your child’s surgeon might:

• make a hole to drain fluid into another area of the brain, where it is absorbed (ventriculostomy)

• put a small tube called a shunt in your child’s brain, so that the fluid drains to another part of the body. This is usually the tummy, where the body gets rid of it

• remove the tumour if it is safe to do so

We have information about what to expect when your child has brain surgery

What if surgery isn’t possible?

Sometimes surgery is not possible because of where the tumour is in the brain. If your child doesn’t have any symptoms, they might suggest that they closely monitor the tumour. This means your child will have regular scans to check for any changes. These types of tumours are slow growing, so might not cause problems for your child for quite a while.

If the tumour is causing symptoms, they might suggest another treatment such as chemotherapy, radiotherapy or a ​targeted cancer drug​ .

Your child’s doctors will talk with you about the other treatment options.

If the surgeon is able to remove most of the tumour your child will be closely followed up. They’re likely to have regular scans, but no further treatment at this stage.

Radiotherapy means the use of radiation, usually with high energy x-rays, to treat cancer. Your child’s team might suggest your child has radiotherapy.

Doctors try to avoid giving radiotherapy treatment to children:

• under the age of 10

• with NF1

This is because they are more at risk of severe side effects during and after treatment.

Read more about radiotherapy

Proton beam therapy is a type of radiotherapy. It uses protons rather than high-energy x-rays to kill cancer cells. Protons are tiny parts of atoms. They work differently from x-rays. They produce a sudden burst of energy when they stop, which stays inside the tumour. So, there is less damage to healthy cells around the tumour.

Research shows that proton beam therapy can work well for some types of children’s brain tumours. This includes some children with low grade astrocytoma.

Your child’s specialist will talk with you if proton therapy might be helpful for your child.

There are 2 therapy centres in the UK and these are at:

• The Christie Hospital in Manchester

• University College London Hospital

University College London Hospital opened in 2021. They’re gradually opening their service to the rest of the UK. At the moment, children who need this service will have to travel to one of these hospitals or abroad.

Find out more about proton beam treatment

Chemotherapy is the use of anti cancer drugs to destroy cancer cells. Your child’s specialist might recommend chemotherapy instead of radiotherapy. Or your child might have chemotherapy and radiotherapy together.

Your child will have most of their chemotherapy into a vein (intravenous).

Chemotherapy can work very well for some types of astrocytoma in babies and young children. The exact combination of drugs and the timing varies. But generally chemotherapy is given every 2 to 6 weeks. Children under 2 years of age when they are diagnosed usually have chemotherapy for about 2 years. After that, your child might have a course of radiotherapy to help stop the astrocytoma from coming back.

Generally, chemotherapy treatment for low grade glioma can last up to a year to 18 months. But your child has most of their treatment on outpatient or daycare ward and can go home after. Many children return to school while having this type of chemotherapy treatment.

It’s difficult for doctors to predict how well chemotherapy will work. Chemotherapy works best at killing cells that are growing and dividing quickly. Low grade tumours are slow growing, so it might take some time to see them shrink.

Find out more about chemotherapy

Targeted cancer drugs are a newer type of treatment. They are grouped together as they work by ‘targeting’ the differences that help a cancer cell survive and grow. There are many different types of targeted drugs. These are grouped together depending on how they work. These groups include monoclonal antibodies, cancer growth blockers, drugs that block cancer blood vessel growth and PARP inhibitors.

Some children might have a targeted cancer drug as their treatment, but this is mainly being looked at in clinical trials. Some of the targeted drugs children might have include:

• bevacizumab

• dabrafenib

• trametinib

Bevacizumab is a monoclonal antibody (MAB). It works by recognising and finding specific proteins in cancer cells. Bevacizumab targets a cancer cell protein called vascular endothelial growth factor (VEGF). This protein helps cancers grow blood vessels, so they can get food and oxygen from the blood. All cancers need a blood supply to be able to survive and grow.

Bevacizumab works by blocking this protein and stops the cancer from growing blood vessels, so it’s starved and can't grow.

Some children might have a targeted cancer drug called bevacizumab to treat low grade astrocytoma. They have this with a chemotherapy drug called irinotecan. They usually only have it after other treatment hasn’t worked.

Find out more about monoclonal antibodies

Some children with low grade astrocytoma have a change (​mutation​ ) in the BRAF gene. The BRAF gene makes a protein that affects how cancers grow and divide. Certain drugs that block the BRAF protein stop cancer growing and spreading, such as dabrafenib and trametinib.

Your child might have dabrafenib and trametinib if they have the BRAF gene change and low grade astrocytoma. And they need treatment that reaches the whole body (​systemic treatment​ ).

Find out more about dabrafenib and trametinib

Your child might have surgery to:

• remove all or as much of the tumour as possible

• take a piece of the tumour to look at under the microscope (a biopsy), to find out for certain what type of tumour it is

After surgery your child might have radiotherapy. They are likely to start treatment quickly after their surgery. Especially if they have lots of symptoms. Radiotherapy uses high energy x-rays to destroy any remaining cancer cells.

Doctors try to avoid giving radiotherapy treatment to children:

• under the age of 3 (this depends on where the tumour is)

• with NF1

This is because they are at higher risk of severe side effects during and after treatment. Doctors might reduce the amount (dose) of radiotherapy or delay it until your child is a bit older to try and prevent these side effects.

Read more about radiotherapy for children’s brain tumours

Research has shown that chemotherapy can help children with high grade astrocytoma. Children with high grade astrocytoma usually have chemotherapy for 6 to 12 months.

If your child is under 3 years of age, they usually have surgery and then chemotherapy. They may also have radiotherapy but this depends on where the tumour is.

For children over 3 years of age, they have surgery and then radiotherapy to the area. Some children may have chemotherapy alongside the radiotherapy. This is called chemoradiotherapy. In most cases children have more chemotherapy after their course of radiotherapy. 

Research continues to look for the best chemotherapy drugs and length of treatment for high grade astrocytoma in children. Because of this, many children who have chemotherapy have it as part of a clinical trial.

Find out about research and clinical trials for children with brain tumours

Targeted cancer drugs are a newer type of treatment. They are grouped together as they work by ‘targeting’ the differences that help a cancer cell survive and grow. There are many different types of targeted drugs. These are grouped together depending on how they work. These groups include monoclonal antibodies, cancer growth blockers, drugs that block cancer blood vessel growth and PARP inhibitors.

Some children might have a targeted cancer drug as their treatment, but this is mainly being looked at in clinical trials.

Some children with high grade astrocytoma have a change (​mutation​ ) in the BRAF gene. The BRAF gene makes a protein that affects how cancers grow and divide. Certain drugs that block the BRAF protein stop cancer growing and spreading, such as dabrafenib and trametinib.

Your child might have dabrafenib and trametinib if they have the BRAF gene change and high grade astrocytoma. And your child has had treatment with radiotherapy or chemotherapy.

Find out more about dabrafenib and trametinib