Treating a Pediatric Brain Tumor
Dr. Jennifer Strahle shares the early signs of a pediatric brain tumor, what the first appointment is like, how a treatment plan is selected, and what Pacific Pediatric Neuro-Oncology Consortium (PNOC) is and why it's so groundbreaking that St. Louis Children's Hospital is a part of this.
Featuring:
Jennifer Strahle, MD
Jennifer Strahle, MD is an Assistant Professor of Neurological Surgery, Orthopedic Surgery and Pediatrics, Director, Pediatric Neuro Spine Program. Transcription:
Dr. Jennifer Strahle (Guest): Hi, my name is Dr. Jennifer Strahle. I work at Washington University in St. Louis at St. Louis Children’s Hospital and I’m a Mom Doc.
Melanie Cole (Host): Hey, welcome this is Mom Docs, the podcast from St. Louis Children’s Hospital, and today we’re talking about treating a pediatric brain tumor. Dr. Strahle, I’m so glad to have you with us. This is such a terrifying prospect for parents, and I think what every parent wants to know when their child complains of a headache or anything, what are some early signs? Are there any or indicators that your child might possibly have a pediatric brain tumor?
Dr. Strahle: That’s a great question. The typical signs that we see in pediatric brain tumor is a constellation of symptoms including headache, combined with nausea and vomiting; however, I would like to emphasize that all of those symptoms by themselves, and even together are extremely common and only a very small portion of kids that have those symptoms will ultimately be diagnosed with a brain tumor.
Host: So then if somebody is worried about this, how is a patient referred to the Brain Tumor Neuro-Oncology program at St. Louis Children’s?
Dr. Strahle: So the typical process is that if someone is having symptoms whether it’s a headache, weakness, a neurologic change, difficulty speaking or seeing, and then other symptoms I mentioned, nausea and vomiting, usually they first present to their pediatrician. If the symptoms are severe enough, occasionally they will come to the emergency room, and any time there’s a concern for something urgent, we always encourage folks to come to the emergency room if they’re unable to see a pediatrician, but usually our kids will first see one of those two providers, pediatrician or ER physician, and then from there will be evaluated, and that’s when they will have a neurologic exam, and the providers will look for other causes for their symptoms, and then if there is a suspicion or a concern for a brain tumor, then usually an image is performed, whether that be a CT scan or an MRI.
Host: So I think when parents are preparing, whether it’s a little toddler or a little bit of an older child for that appointment to see you and they don’t want to scare the child, what’s that first appointment like?
Dr. Strahle: So usually when patients come to our center here, to our Pediatric Neuro-Oncology Group at St. Louis Children’s Hospital, the diagnosis is usually already made, whether that’s through the pediatrician or through the ER, they will have an image, and depending on the age of the child, with our young infants, we usually do have a direct conversation with the parents in our office. If the child is a little bit older, we will occasionally have a separate conversation with mom and dad and we’re usually able to discuss with the parents what the child already knows and it really depends on each specific individual child and family about how best to relay this new diagnosis and new information. So it’s really on a patient to patient basis on how we talk with both the family and the patients themselves.
Host: What have you found? How do you reassure parents and even the child themselves that there are treatment options available and that you can help them? What do you say to them?
Dr. Strahle: So the diagnosis of a brain tumor, just that phrase in and of itself is a very scary term, and when any family hears that, there’s an initial reaction of worry and the fact is though that many, many brain tumors, almost all of them are treatable in some fashion and there are many different types of brain tumors, some require one type of treatment, others require another and I can talk to you about that in a second. There are a few types of brain tumors that are more difficult to treat and that we do have some limitations with but overall we have a lot of options for anyone who presents with a brain tumor and that’s in part through our connection with the Pediatric Neuro-Oncology Consortium which is a consortium of hospitals across the United States that offer innovative and unique clinical trials to really be at the cutting edge of treatment for pediatric brain tumors.
Host: Well since you brought that up, tell us what that is, the Pacific Pediatric Neuro-Oncology Consortium and why is it so groundbreaking that St. Louis Children’s Hospital is a part of this?
Dr. Strahle: So we are connected with fights across the country to both participate and develop clinical trials for children with both pediatric brain and spinal cord tumors. Not only do we develop clinical trials but there’s also investigations into the biology of the tumors and more and more we’re learning new information about pediatric brain tumors that we didn’t know before. So for instance, even 10 years ago, a number of brain tumors were all considered to be the same thing and grouped into one big category. We now know that a lot of the brain tumors are more unique, and so they’re really in a lot of cases a more individualized treatment for pediatric brain tumors based on the specific DNA or genetics of that specific tumor, and so being part of this consortium allows us to offer the most innovative treatments for our patients as well as be part of the ground breaking research that goes on behind the scenes to learn more about the tumor’s behavior themselves.
Host: So then based on what you’d find in your diagnosis, how is an appropriate course of treatment, whether it’s surgery, or radiation, or chemo selected for a patient? We don’t have a lot of time in these, but explain briefly for parents the options of protein beam or bone marrow transplantation, how do you decide?
Dr. Strahle: The decision about what treatment is going to be best for a child with a brain tumor depends on both where the brain tumor is located, if it’s in a single spot or more than one spot, and then the tumor itself, so what kind of tumor it is. And because we know a lot about the tumors that we see here, there are standard treatments for a lot of tumors that we see, so the three treatments that are typically used to treat brain tumors include surgery, so surgically removing the tumor. The second is radiation and there are several types of radiation, one of which is proton beam, and here at Wash U, we do have a protein beam radiation which is not offered in a lot of locations and that allows us to specifically tailor radiation treatments to very precise locations in the brain to avoid radiation exposure to critical structures in the brain that could be injured by the radiation. And then finally there’s chemotherapy. Chemotherapy can take the form of oral medication up to multiple medications which require a hospitalization, and in some cases are combined with something like a bone marrow transplant. All three of those treatments are considered and discussed for each individual patient. We have a multidisciplinary neuro-oncology conference every week where we talk about all of our patients who are currently being treated and assess the need for any one of those treatments or in combination to ensure that we are optimizing treatment for that individual.
Host: Wow, isn’t that fascinating. So tell us Dr. Strahle, in these cancer treatments, how do you decide or determine that a child is either in remission or cured of this tumor, how is success defined?
Dr. Strahle: The definition of success varies for the tumor type. So for some tumors, success is defined by the tumor being completely removed or treated without any evidence of residual tumor and that is the definition of success that is used for a lot of tumors. We also talk about success in terms of control of the tumor ensuring that if it is in a spot that is difficult to take out, that it is stable and localized to that one specific spot and not growing, so that is another definition of success for some type of tumors, but really our goal in treating all patients is to work to eliminate the tumor and prevent it from coming back.
Host: So tell us a little bit as we wrap up some of the long term consequences of how the treatments had been for brain tumors and children and what you see may be different now. What can parents expect for their children and give them some hope about what’s going on in the future and some of the research that you’re seeing going on.
Dr. Strahle: So treatment for pediatric brain tumors is a really, really exciting field and it’s a very exciting time for treatment of brain tumors because we’re rapidly learning a lot more about brain tumors than we ever knew before. So for instance, there are continually more and more drugs that are being developed that specifically target specific aspects of the tumor, so all of our tumors are sent for DNA analysis. Just as we all have DNA in our bodies, each of the tumors have its own DNA, and if there are specific changes in the DNA of the tumor, there are new drugs that are able to specifically target those changes to specifically treat that tumor, and that is something new that we’re seeing more and more of and the diagnosis of tumors used to be seeing how the tumor looked on a cellular level under the microscope, and now a lot of our tumors are both categorized and treated based on our DNA, which is a really exciting time in neuro-oncology.
Host: So give parents some hope out there and what you want them to know if their children experience any of these symptoms, or if God forbid they’re told and this is what they need to do and you are who they need to see.
Dr. Strahle: So I’d first like to say that pediatric brain tumors are treatable. We see many tumors each day that are completely treatable where we’re able to use the tools we have, whether it be through surgery or radiation or chemotherapy to completely treat the tumors that we see, and because we are located in both St. Louis Children’s Hospital and Washington University in St. Louis, and we’re part of the Pediatric Neuro-Oncology Consortium, we have access to many, many, many clinical trials, and not only have access to these clinical trials but are also participating and leading the way in terms of developing new tools and new treatments for pediatric brain tumors. So if you find yourself with the diagnosis of a pediatric brain tumor, there is a lot of hope for great treatments and we are here to make sure that you receive the best care and access to all innovative and cutting edge treatments that are available.
Host: Thank you so much Dr. Strahle for coming on and sharing your incredible expertise. This is something that every parent – every parent is terrified of, but you really have explained it so very clearly about the treatment options and the hope and the research that’s going on in this field. Thank you again. And that wraps up another episode of Mom Docs with St. Louis Children’s Hospital. Head on over to our website at stlouischildrens.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with other parents, share with your friends and family on social media and be sure to check out all the other very cool podcasts in our library. Until next time, this is Melanie Cole.
Dr. Jennifer Strahle (Guest): Hi, my name is Dr. Jennifer Strahle. I work at Washington University in St. Louis at St. Louis Children’s Hospital and I’m a Mom Doc.
Melanie Cole (Host): Hey, welcome this is Mom Docs, the podcast from St. Louis Children’s Hospital, and today we’re talking about treating a pediatric brain tumor. Dr. Strahle, I’m so glad to have you with us. This is such a terrifying prospect for parents, and I think what every parent wants to know when their child complains of a headache or anything, what are some early signs? Are there any or indicators that your child might possibly have a pediatric brain tumor?
Dr. Strahle: That’s a great question. The typical signs that we see in pediatric brain tumor is a constellation of symptoms including headache, combined with nausea and vomiting; however, I would like to emphasize that all of those symptoms by themselves, and even together are extremely common and only a very small portion of kids that have those symptoms will ultimately be diagnosed with a brain tumor.
Host: So then if somebody is worried about this, how is a patient referred to the Brain Tumor Neuro-Oncology program at St. Louis Children’s?
Dr. Strahle: So the typical process is that if someone is having symptoms whether it’s a headache, weakness, a neurologic change, difficulty speaking or seeing, and then other symptoms I mentioned, nausea and vomiting, usually they first present to their pediatrician. If the symptoms are severe enough, occasionally they will come to the emergency room, and any time there’s a concern for something urgent, we always encourage folks to come to the emergency room if they’re unable to see a pediatrician, but usually our kids will first see one of those two providers, pediatrician or ER physician, and then from there will be evaluated, and that’s when they will have a neurologic exam, and the providers will look for other causes for their symptoms, and then if there is a suspicion or a concern for a brain tumor, then usually an image is performed, whether that be a CT scan or an MRI.
Host: So I think when parents are preparing, whether it’s a little toddler or a little bit of an older child for that appointment to see you and they don’t want to scare the child, what’s that first appointment like?
Dr. Strahle: So usually when patients come to our center here, to our Pediatric Neuro-Oncology Group at St. Louis Children’s Hospital, the diagnosis is usually already made, whether that’s through the pediatrician or through the ER, they will have an image, and depending on the age of the child, with our young infants, we usually do have a direct conversation with the parents in our office. If the child is a little bit older, we will occasionally have a separate conversation with mom and dad and we’re usually able to discuss with the parents what the child already knows and it really depends on each specific individual child and family about how best to relay this new diagnosis and new information. So it’s really on a patient to patient basis on how we talk with both the family and the patients themselves.
Host: What have you found? How do you reassure parents and even the child themselves that there are treatment options available and that you can help them? What do you say to them?
Dr. Strahle: So the diagnosis of a brain tumor, just that phrase in and of itself is a very scary term, and when any family hears that, there’s an initial reaction of worry and the fact is though that many, many brain tumors, almost all of them are treatable in some fashion and there are many different types of brain tumors, some require one type of treatment, others require another and I can talk to you about that in a second. There are a few types of brain tumors that are more difficult to treat and that we do have some limitations with but overall we have a lot of options for anyone who presents with a brain tumor and that’s in part through our connection with the Pediatric Neuro-Oncology Consortium which is a consortium of hospitals across the United States that offer innovative and unique clinical trials to really be at the cutting edge of treatment for pediatric brain tumors.
Host: Well since you brought that up, tell us what that is, the Pacific Pediatric Neuro-Oncology Consortium and why is it so groundbreaking that St. Louis Children’s Hospital is a part of this?
Dr. Strahle: So we are connected with fights across the country to both participate and develop clinical trials for children with both pediatric brain and spinal cord tumors. Not only do we develop clinical trials but there’s also investigations into the biology of the tumors and more and more we’re learning new information about pediatric brain tumors that we didn’t know before. So for instance, even 10 years ago, a number of brain tumors were all considered to be the same thing and grouped into one big category. We now know that a lot of the brain tumors are more unique, and so they’re really in a lot of cases a more individualized treatment for pediatric brain tumors based on the specific DNA or genetics of that specific tumor, and so being part of this consortium allows us to offer the most innovative treatments for our patients as well as be part of the ground breaking research that goes on behind the scenes to learn more about the tumor’s behavior themselves.
Host: So then based on what you’d find in your diagnosis, how is an appropriate course of treatment, whether it’s surgery, or radiation, or chemo selected for a patient? We don’t have a lot of time in these, but explain briefly for parents the options of protein beam or bone marrow transplantation, how do you decide?
Dr. Strahle: The decision about what treatment is going to be best for a child with a brain tumor depends on both where the brain tumor is located, if it’s in a single spot or more than one spot, and then the tumor itself, so what kind of tumor it is. And because we know a lot about the tumors that we see here, there are standard treatments for a lot of tumors that we see, so the three treatments that are typically used to treat brain tumors include surgery, so surgically removing the tumor. The second is radiation and there are several types of radiation, one of which is proton beam, and here at Wash U, we do have a protein beam radiation which is not offered in a lot of locations and that allows us to specifically tailor radiation treatments to very precise locations in the brain to avoid radiation exposure to critical structures in the brain that could be injured by the radiation. And then finally there’s chemotherapy. Chemotherapy can take the form of oral medication up to multiple medications which require a hospitalization, and in some cases are combined with something like a bone marrow transplant. All three of those treatments are considered and discussed for each individual patient. We have a multidisciplinary neuro-oncology conference every week where we talk about all of our patients who are currently being treated and assess the need for any one of those treatments or in combination to ensure that we are optimizing treatment for that individual.
Host: Wow, isn’t that fascinating. So tell us Dr. Strahle, in these cancer treatments, how do you decide or determine that a child is either in remission or cured of this tumor, how is success defined?
Dr. Strahle: The definition of success varies for the tumor type. So for some tumors, success is defined by the tumor being completely removed or treated without any evidence of residual tumor and that is the definition of success that is used for a lot of tumors. We also talk about success in terms of control of the tumor ensuring that if it is in a spot that is difficult to take out, that it is stable and localized to that one specific spot and not growing, so that is another definition of success for some type of tumors, but really our goal in treating all patients is to work to eliminate the tumor and prevent it from coming back.
Host: So tell us a little bit as we wrap up some of the long term consequences of how the treatments had been for brain tumors and children and what you see may be different now. What can parents expect for their children and give them some hope about what’s going on in the future and some of the research that you’re seeing going on.
Dr. Strahle: So treatment for pediatric brain tumors is a really, really exciting field and it’s a very exciting time for treatment of brain tumors because we’re rapidly learning a lot more about brain tumors than we ever knew before. So for instance, there are continually more and more drugs that are being developed that specifically target specific aspects of the tumor, so all of our tumors are sent for DNA analysis. Just as we all have DNA in our bodies, each of the tumors have its own DNA, and if there are specific changes in the DNA of the tumor, there are new drugs that are able to specifically target those changes to specifically treat that tumor, and that is something new that we’re seeing more and more of and the diagnosis of tumors used to be seeing how the tumor looked on a cellular level under the microscope, and now a lot of our tumors are both categorized and treated based on our DNA, which is a really exciting time in neuro-oncology.
Host: So give parents some hope out there and what you want them to know if their children experience any of these symptoms, or if God forbid they’re told and this is what they need to do and you are who they need to see.
Dr. Strahle: So I’d first like to say that pediatric brain tumors are treatable. We see many tumors each day that are completely treatable where we’re able to use the tools we have, whether it be through surgery or radiation or chemotherapy to completely treat the tumors that we see, and because we are located in both St. Louis Children’s Hospital and Washington University in St. Louis, and we’re part of the Pediatric Neuro-Oncology Consortium, we have access to many, many, many clinical trials, and not only have access to these clinical trials but are also participating and leading the way in terms of developing new tools and new treatments for pediatric brain tumors. So if you find yourself with the diagnosis of a pediatric brain tumor, there is a lot of hope for great treatments and we are here to make sure that you receive the best care and access to all innovative and cutting edge treatments that are available.
Host: Thank you so much Dr. Strahle for coming on and sharing your incredible expertise. This is something that every parent – every parent is terrified of, but you really have explained it so very clearly about the treatment options and the hope and the research that’s going on in this field. Thank you again. And that wraps up another episode of Mom Docs with St. Louis Children’s Hospital. Head on over to our website at stlouischildrens.org for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with other parents, share with your friends and family on social media and be sure to check out all the other very cool podcasts in our library. Until next time, this is Melanie Cole.