Treatment Options

Currently, there are no proven treatments for PLGA tumors right now. However, treatment options typically follow these three steps:

First: immediately following the detection of a PLGA (usually by MRI or CT scans), the patient usually undergoes a biopsy procedure. This phase can be performed in conjunction with a more extensive surgical resection, or independently, depending on tumor location.

Second: parents, medical experts, and the affected child develop a treatment plan (again, there is NO one protocol). The Neuropathologist (a doctor who specializes in looking at brain tumor cells) will examine the tumor cells from the operation to determine the type of tumor. Together, the oncologist, radiation therapist, and neurosurgeon decide on the best options and make a recommended plan of care.

Third: a treatment plan is initiated. Currently, three options are widely used: chemotherapy, radiation, and wait-and-see (and in some cases, a combination of chemo and radiation). The therapy is determined by many factors: type of tumor, its location, and your child's age.

After each treatment option is administered, there is usually a wait-and-see period where the physicians observe the tumor (usually 3 – 6 months) through an MRI and/or CAT scan. They then make follow-up recommendations based on these findings.

Typical tests/procedures that might be utilized

Tests that examine the brain and spinal cord are used to detect (find) childhood cerebellar astrocytoma. The following tests and procedures may be used:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Biopsy: A biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

Current Treatment Options for PLGA

According to experts, current treatments are limited to surgery, chemotherapy and radiation. All three options may offer conflicting and potentially incomplete solutions. All three also often result in added critical complications and permanent adverse side effects due to the punishing nature of the therapies. Furthermore, a subset of PLGA kids, estimated 30-40% overall, will develop progressive disease, according to experts and treatments are far from optimal. These experts say that although radiation and chemo is being made safer it is unlikely to cure many more children with PLGA. In a similar way many experts predict that new chemotherapy regimes will not make "quantum leaps" in the statistics of survival.

Experimental Therapies - Immuno-Vacines

Immuno-vaccines are still very new to the brain tumor arena and historically have been focused on the adult brain tumor population.  That being said, new advances suggest that there may  be a higher likelihood that immuno-vaccines may be a treatment option in the future for children with brain tumors.   At the July 2nd, 2008 International Society of Pediatric Neuro-Oncologists meeting in Chicago, more than 100 families with children suffering from brain tumors gathered to ask questions directed at an interdisciplinary panel of pediatric brain tumor physicians.  In this short video, Dr. Kieran shares with the audience some of the new insights into potential immuno-vaccine treatments for pediatric brain tumor patients." 

How to Find Kinder/Gentler Treatment Options

Families of children with PLGA have held false hopes that research advances were progressing rapidly. This is NOT the case. Historically, PLGA has lagged behind advancements in other childrens’ cancers, such as childhood leukemia, due to lack of funding. As a result, many new drugs have not been tested on PLGA, and clinical studies have been stalled.

In May 2005, the first world-wide PLGA/JPA Symposium was convened by a group of fightJPA.org parents. World leaders, experts, in the pediatric brain tumor field joined together for a two day conference to discuss possible research study strategies targeted at PLGA/JPA. They determined that, given recent technological scientific advances, current research initiatives would be poised to make progress if funding were available. (See the Executive Summary of the JPA/PLGA Workshop)

In June 2008, the PLGA Foundation co-sponsored (with the Brain Tumor Society) a Low Grade Glioma Symposium at the International Society of Pediatric Neuro-Oncologists meeting in Chicago.  The international meeting brought together over 900 physicians/clinicians/care givers from around the world and the Low Grade Glioma Symposium was attended by over 500 of these experts.  Never before has there been such a strong interest in this critically under researched area.  Two key note speakers and twenty abstracts held the attention of this group for over four hours.  It is our hope that from this strong showing will come an increased pool of talented researchers who are will apply for grants through the PLGA Foundation, and other pediatric brain tumor foundations, for targeted research initiatives. 

Finding less toxic and more effective treatments for PLGA children will be possible through the collaboration of all interested parties.   Most importantly, with the new-found spirit of collaboration between all medical disciplines as well as lay person resources (parent, families, caregivers, etc.) the possibility of finding these new treatments and a cure is even more realistic.   At the ISPNO meeting, more than 100 families with children suffering from brain tumors gathered to ask questions directed at an interdisciplinary panel of pediatric brain tumor physicians.  In this short video, Dr. Roger Packer and Dr. Mark Kieran share with the audience some of their insights into the potential for an accelerated pace of research based on the new, collaborative focus of medical experts around the world.