Adjuvant Therapy for Focal Brainstem Gliomas in Children

Radiation Therapy

• Conventional radiation therapy: Conventional radiation therapy has limited efficacy in patients with focal midbrain tumors (30,46).  Tumors with anaplastic or malignant features should be treated with radiation therapy after the patient recovers from surgery, whereas benign tumors may be observed and treated only if there is subsequent tumor growth (27).
• Brachytherapy: Seeds of iodine-129 or iodine-125 have been implanted in some patients with acceptable results in control of the tumor growth (47). I-125 is an alternative to resection, external radiotherapy, and chemotherapy in children with progressively symptomatic low-grade gliomas in deep and eloquent areas for whom high postoperative morbidity would be expected with open surgery (48).
• Stereotactic radiosurgery: The use of stereotactic radiosurgery as an alternative means for the management of focal brainstem gliomas has been reported in patients with progressive tumor growth or worsening neurological deficits (35).

Chemotherapy

• Uncertain role: The role of chemotherapy has not been well evaluated for focal brainstem tumors.  In general, for sub-totally or completely resected tumors that subsequently progress, chemotherapy may be considered with or without radiation therapy.  In young children, chemotherapy may be used alone in an attempt to delay the need for radiation therapy.