• Pilocytic Astrocytoma in Children

    A pilocytic astrocytoma is a brain tumor that originates from star-shaped cells called astrocytes. Astrocytes are a kind of glial cell, cells that support and nourish neurons in the brain.

    An astrocytoma is a type of glioma. Pilocytic astrocytomas are low-grade gliomas—a family of slow-growing tumors that arise from glial cells. They are the most benign and most treatable of the gliomas, with a cure rate of over over 90 percent.

    Pilocytic Astrocytoma Treatment at Dana-Farber/Boston Children's

    Children and adolescents with glioma are treated at Dana-Farber/Boston Children’s through the Brain Tumor Center's Glioma Program, one of the largest and most experienced pediatric glioma programs in the world.

    Our glioma specialists—a team of neuro-oncologists, surgeons, pathologists, and radiation oncologists—focus solely on the care of children diagnosed with gliomas. The Glioma Program also offers families the chance to have their child's tumor molecularly profiled (as long as a biopsy can be taken), which may help identify opportunities for targeted treatment.

    Continue reading to learn more about pediatric gliomas: read our overview of childhood brain tumors or visit our Glioma Program page to learn about our expertise and treatment options.

    What are the symptoms of a pediatric pilocytic astrocytoma?

    As a pilocytic astrocytoma grows, it presses on surrounding healthy parts of the brain, affecting their function. As such, the symptoms of a pediatric pilocytic astrocytoma depend on the tumor's size and where in the brain it is located.

    Some of the most common symptoms of a pediatric pilocytic astrocytoma include:

    • headache, particularly in the morning or made better by vomiting
    • severe or frequent vomiting without other signs of gastrointestinal illness
    • vision problems, such as double vision, blurry vision, or loss of vision
    • difficulty walking or balancing
    • seizures
    • weight gain or loss
    • premature puberty
    • clumsiness
    • confusion
    • sleepiness
    • changes in behavior

    Because these tumors grow so slowly, children may experience symptoms for months before seeing a doctor. However, in some children, symptoms come on very quickly because the tumor blocks the flow of cerebrospinal fluid—a liquid that cushions the brain and spinal cord—within the brain.

    How is a pediatric pilocytic astrocytoma diagnosed?

    To diagnose a pediatric pilocytic astrocytoma, your doctor will take your child's medical history and carry out both physical and neurological exams. Your doctor may also order a variety of tests, including:

    • a magnetic resonance imaging (MRI) scan to evaluate the tumor and determine its extent
    • biopsy or tissue sample from the tumor to provide definitive information about the type of tumor and its grade, and allow for molecular profiling of tumor cells
    • electroencephalogram (EEG), which measures the brain's electrical activity
    • lumbar puncture, in which a doctor takes a small sample of cerebrospinal fluid from near the base of the spine to see whether the tumor has spread

    After all tests are completed, doctors will be able to outline the best treatment options.

    How is pediatric pilocytic astrocytoma treated?

    Our treatment approach for pediatric gliomas is personalized for each patient depending on several factors, including the tumor's type, stage, and location. Some therapies will treat the tumor while others are intended to address complications of the disease or side effects of the treatment.

    In addition, our clinicians may offer access to targeted treatments based on the molecular profile of your child's tumor.

    Some of the options your doctor may discuss include:

    • surgery to remove as much of the tumor as possible
    • chemotherapy, either before surgery to shrink the tumor or after surgery to eliminate any remaining tumor cells
    • radiation therapy; while this was once the standard of care, this option is now generally avoided in children with pilocytic astrocytomas to avoid possible long-term side effects

    For pilocytic astrocytomas, often surgery is the only treatment required.

    We also offer innovative brain tumor clinical trials for children with pilocytic astrocytomas. Some have been launched by our own physicians, while others are available through our participation in collaborative groups such as the Children's Oncology Group (COG) and the Pacific Pediatric Neuro-Oncology Consortium (PNOC).

    Should you have questions or need advice on whether a particular trial would be appropriate for your child, email our clinical trials team at clinicaltrials@danafarberbostonchildrens.org. We can help you navigate your options.

    What is the long-term outlook for children with pilocytic astrocytoma?

    Innovative treatments have led to very high cure rates of 90 percent to 95 percent. Children cured of pilocytic astrocytoma enjoy a quality of life better than most other children with cancer. Balance, strength, and coordination may be compromised, but fertility and life expectancy are not.

    What is the latest research on pilocytic astrocytomas in children?

    Research is a top priority at Dana-Farber/Boston Children's, and our physicians work continuously to translate laboratory findings into clinical therapies and find ways to improve survival while reducing the toxicity and long-term impact of treatment.

    For instance, a 2014 study led by Peter Manley, MD, documented the excellent long-term survival among patients with low-grade gliomas and the negative impact of radiation therapy—long a mainstay of pediatric brain tumor treatment—on that survival.

    The Glioma Program's research enterprise mirrors its clinical efforts in its multidisciplinary nature. Basic, translational, and clinical scientists in the program work together and with colleagues at institutions like the Broad Institute to uncover new knowledge about the biology of gliomas and translate that understanding into new therapies or ways of overcoming resistance to existing ones.

    Dana-Farber/Boston Children's houses the Pediatric Low-Grade Astrocytoma (PLGA) Program, the world's only multidisciplinary clinical and research program dedicated to pediatric low-grade gliomas. Established in 2007 with support from the PLGA Foundation, the program takes a multifaceted approach to finding more effective, less toxic treatments and a cure for children battling brain tumors, and has become the standard bearer for the research and care of pediatric brain tumors. Our pediatric neuro-oncologists, including Pratiti (Mimi) Bandopadhayay, MBBS, PhD, are actively contributing to these efforts. Our program has contributed to international research efforts that have identified genomic drivers that contribute to growth of pilocytic astrocytoma. Specifically, we have identified genes that are commonly mutated in pilocytic astrocytoma. These findings are guiding clinical trials examining the activity of new drugs specifically for children with pilocytic astrocytoma.

    It’s possible that your child will be eligible to participate in one of the Glioma Program’s current brain tumor clinical trials. In addition to launching our own clinical trials, we also offer trials available through collaborative groups such as the Children's Oncology Group (COG) and the Pacific Pediatric Neuro-Oncology Consortium (PNOC).

  • Brain Tumor Clinical Trials

    Through research and clinical trials, we are leading the way in improving survival rates for hard-to-treat pediatric brain tumors.callout bg