Scheryll Paula Alken

High-Grade Glioma

High-grade gliomas are defined as tumors of glial origin with a very low incidence rate in infants and young children. They form part of the spectrum of primary intrinsic CNS and spinal cord tumors of children although their proportionate frequency of all primary CNS and spinal cord tumors is significantly lower compared to the adult population. The overwhelming number of newly diagnosed cases are sporadic primary tumors presenting with either signs of raised intracranial pressure, seizures, or other more nonspecific neurological symptoms. The initial management is aimed at restoring CSF flow, alleviation of existing mass effect, and establishing a pathological diagnosis. Ideally, the primary surgical approach is aimed at achieving a macroscopic complete excision without postoperative severe and permanent neurologic deficits. While primary chemotherapy is the preferred mode of adjuvant treatment in infants under the age of 3 years, the standard of care in all other patients is the use of combined focal radiotherapy and chemotherapy. Long-term outcome remains poor albeit appears generally slightly better than their adult counterparts.

Managing teenage/young adult (TYA) brain tumors: a UK perspective

Tumors of the CNS are among the commonest malignancies occurring in teenage/young adult patients (i.e., those aged between 15 and 24 years). The treatment of this patient population is challenging. Adolescence and young adulthood are a turbulent period of life, with physical, emotional, social and cognitive changes. Best practice advocates their treatment in dedicated teenage/young adult units, with multidisciplinary team input and access to clinical trials. Treatment of CNS malignancies is dependent upon histological subtype and staging, with varying combinations of surgery, radiotherapy and chemotherapy used. Clinical trials directly targeted at this patient population are rare; treatments are based on pediatric protocols as studies have demonstrated improved outcomes in patients (with other malignancies) treated as such. Scope for improvement lies in minimizing patient risk of recurrence and long-term sequelae of treatment. Molecular characterization of tumors may provide further information.