Brain tumors in childhood: implications for nursing practice

Essential Management of Pediatric Brain Tumors

Brain tumors are the most common solid tumors in children and are associated with high mortality. The most common childhood brain tumors are grouped as low-grade gliomas (LGG), high grade gliomas (HGG), ependymomas, and embryonal tumors, according to the World Health Organization (WHO). Advances in molecular genetics have led to a shift from pure histopathological diagnosis to integrated diagnosis. For the first time, these new criteria were included in the WHO classification published in 2016 and has been further updated in the 2021 edition. Integrated diagnosis is based on molecular genomic similarities of the tumor subclasses, and it can better explain the differences in clinical courses of previously histopathologically identical entities. Important advances have also been made in pediatric neuro-oncology. A growing understanding of the molecular-genetic background of tumorigenesis has improved the diagnostic accuracy. Re-stratification of treatment protocols and the development of targeted therapies will significantly affect overall survival and quality of life. For some pediatric tumors, these advances have significantly improved therapeutic management and prognosis in certain tumor subgroups. Some therapeutic approaches also have serious long-term consequences. Therefore, optimized treatments are greatly needed. Here, we discuss the importance of multidisciplinary collaboration and the role of (pediatric) neurosurgery by briefly describing the most common childhood brain tumors and their currently recognized molecular subgroups.

Central nervous system tumors in children

OBJECTIVES

To examine how pediatric and adult central nervous system (CNS) tumors differ and to discuss the unique aspects of diagnosis, treatment, and long-term effects of brain tumors in children.

DATA SOURCES

Research, review articles, book chapters, and abstracts.

CONCLUSIONS

A child's growing and developing body and brain place him or her at great risk for permanent damage as a result of traditional treatment methods. A family-centered nursing approach assists the child and family in coping with the impact of a brain tumor.

IMPLICATIONS FOR NURSING PRACTICE

Children have unique needs during and following treatment for CNS tumors. All oncology nurses need to be fully informed about and help monitor for intellectual, endocrinologic, and oncogenic late effects from the disease and treatment.

Pediatric brain tumors: diagnosis and management

Pediatric brain tumors are the most common solid tumor and the second most common neoplasm in childhood. Confirmation of diagnosis is made by visualization of the tumor on a computed tomographic or magnetic resonance imaging scan. Treatment includes surgery followed by observation or chemotherapy and/or radiation therapy, depending on the amount of tumor removed and its histological characteristics. Recent advances in neuroradiology, neurosurgical techniques, and neuro-oncology have begun to impact the length and quality of survival of children diagnosed with brain tumors. A multidisciplinary approach in the treatment of these children is necessary with the nurses and/or nurse practitioners as the consistent members of the team often coordinating the care.

The role of stereotactic radiation therapy in the management of children with brain tumors

Conventional radiation therapy plays an important role in the management of intracranial tumors in children. For certain tumors radiation therapy serves as the primary mode of treatment, and for others it plays an adjuvant role with surgery and/or chemotherapy. Improvements in long-term survival rates have focused attention on the long-term sequelae of brain tumors and their treatment, and the sequelae, in turn, have become important targets for clinical investigation. Long-term side effects of particular concern in children include cranial nerve damage, memory and intellectual deficits, pituitary-hypothalamic dysfunction, demyelinization of brain tissue, and secondary malignancies. A new form of radiation therapy, stereotactic radiotherapy (SRT), merges the technologies of stereotactic surgery and conventional fractionated radiotherapy. The intent is to deliver maximum tumoricidal doses to the target while limiting the dose to normal surrounding brain tissue. The key feature of SRT is a noninvasive, relocatable immobilization system to assure accurate and reproducible positioning during planning and treatment. The headframes used for children have been modified to address their specific needs. The complexities of this process require careful preparation of patients and their families and the participation of many disciplines. Long-term follow-up will be essential to evaluate the effectiveness of this innovative treatment.