Brain and Spinal Tumor Treatments

Brain and spinal tumors require collaboration and discussion among specialists to determine the most effective treatment options.

The Norton Children’s Brain & Spinal Tumor Program brings together specialists from Norton Children’s Neuroscience Institute and Norton Children’s Cancer Institute, both affiliated with the UofL School of Medicine, to develop a customized treatment plan for each child. In addition to being leaders in their fields, these physicians are actively involved as principal investigators in clinical trials of new and experimental treatments.

Once the type, size and location of the tumor are established, the Brain & Spinal Tumor Program’s brain tumor board meets to discuss the child’s case. Expertise and experience from specialists in neuro-oncology, neurosurgery, radiation oncology, behavioral oncology, neuropathology, neuroradiology and neuropsychology are combined to customize the treatment approaches for each child. This includes discussing all the benefits and risks of various treatments.

Some patients benefit from a molecular profile of the tumor. This can be referred to as a tumor genomic profile. The result is detail of the genetic makeup of the tumor that can assist in delivering highly customized medication that directly attacks the tumor’s genomes.

Norton Children’s specialists will discuss the results of the molecular profile at a molecular tumor board. These meetings can consist of oncologists, pathologists, geneticists, molecular biologists and oncology pharmacists. The goal is to discuss all potential strategies for patients who are not responding to standard treatments such as chemotherapy and radiation.

Children also benefit from treatment in our integrated rehabilitation facility. The rehab team includes physical and occupational therapists who begin therapy as early as possible during cancer treatment to give patients the greatest benefit.

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One or more of the following treatments will be used in a child’s care plan:

Surgery

For infants and children, surgery often is the first step in diagnosing and treating a brain tumor. Our goal is to remove as much of the tumor as safely possible. Surgery also may be done as a biopsy to determine an exact diagnosis of the tumor type.

Other benefits of surgery include:

Reducing the size of the tumor
Relieving intracranial pressure and symptoms, such as headaches and blurred vision
Reducing the amount of radiation or chemotherapy needed to treat the remaining tumor

Increasingly, brain tumors are treated with minimally invasive surgery that involves making small holes in the skull where precise tools can be inserted.

Minimally Invasive Technology

Laser interstitial thermal therapy (LITT) is a technique used at the Brain & Spinal Tumor Program to kill the tumor precisely with heat. Using advanced imaging, including a 3D map of the brain, the child’s physician uses the NeuroBlate LITT device to plot a path to the tumor that avoids vital brain functions and delivers treatment only to the tumor, sparing surrounding healthy tissue.
The ROSA robotic system provides surgeons with even greater precision by helping guide the LITT tool to the tumor. The 3D imaging helps surgeons use ROSA’s robotic arm to thread tiny tools through holes the width of a spaghetti noodle to the source of the tumor. ROSA often allows surgeons to avoid opening the skull, called a craniotomy, to access the tumor.

Radiation Therapy

Using high-energy X-rays, our radiation oncologists can precisely target a child’s tumor. Radiation therapy is used to safely shrink or eliminate tumors by attacking diseased tissue while aiming to spare healthy tissue. Even tumors that can’t be removed safely through surgery can be treated with precision radiation. Radiation therapy is used after surgery and sometimes in combination with chemotherapy.

There are many types of radiation therapy, and our care team has access to a wide range of tools to deliver radiation directly to the tumor while protecting as much normal tissue as possible.

TrueBeam STx – This is a radiosurgery system that allows radiation oncologists to target tumors that may be hard to reach in surgery. Images that capture the shape and location of the child’s tumor — as well as the child’s natural breathing movements — allow the radiation beams to target the tumor without the need to attach a halo to the child’s skull to hold them steady.
Stereotactic radiosurgery – A high dose of radiation is administered to the tumor while sparing healthy tissue, usually in a single treatment. The radiation damages the tumor cells’ DNA, making them incapable of reproducing, and closes off the blood vessels to the tumor. Eventually, the tumor withers.To avoid harming healthy tissue, the procedure aims multiple beams of radiation at the tumor from multiple directions. Each beam by itself isn’t harmful, but when all the beams meet at the site of the tumor, their effect is significant.
Intensity-modulated radiation therapy (IMRT) – Higher doses of radiation are delivered to the tumor, and surrounding tissue gets lower doses. The intensity of individual beams is changed, or modulated, to put the most intense dosage on the tumor.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy usually is given as a pill or given through an IV into a vein. Because many chemotherapy drugs aren’t able to enter the brain and reach tumor cells, they most often are used in combination with surgery and radiation therapy.

The body’s natural blood-brain barrier protects the brain from possible toxins in the blood while allowing nutrients in. Some chemotherapy drugs are better than others at crossing this barrier. Some treatments involve implanting small wafers at the site of the tumor’s surgical removal to deliver the chemotherapy medication.

During treatment, the child will have regular MRI scans to monitor whether the tumor is responding to the treatment. Chemotherapy side effects depend on the patient, the type and dose of drugs, and how long treatment lasts, but usually go away after treatment is finished.

What to Expect From Norton Children’s Brain & Spinal Tumor Program

If your child has just been diagnosed, we offer same-day and next business day appointments for urgent referrals.
Each child’s case is reviewed by a board of specialists who discuss possible treatment plans, so the patient benefits from a broad array of expertise, experience, training and research.
Neurologists, oncologists and other specialists see patients at the same location, making travel easier for families because appointments are scheduled for the same day.
Board-certified and fellowship-trained specialists at the forefront of new treatment advances work to attack tumors while protecting healthy brain and spinal tissue.
Norton Children’s Hospital is part of an elite group of pediatric hospitals that perform MRI-guided laser ablation surgery using the minimally invasive Visualase system to destroy diseased tissue, including deep brain tumors.
Support groups, social workers, psychiatrists, school liaison specialists and child life specialists identify and address the needs of patients and their families during and after medical treatment.
We help prepare for the transition back to school, determine appropriate educational placement and identify any additional services through a neuropsychologist evaluation.
Integrated rehabilitation by physical and occupational therapists begins as early as possible during treatment to give patients the greatest benefit.
Communicate with your provider, manage appointments, refill prescriptions and more anytime from a computer or mobile device with a free Norton MyChart account.