Question:  What are the treatments for Childhood Brain Stem Glioma ?
Answer: Key Points
                    - There are different types of treatment for children with brain stem glioma.     - Children with brain stem glioma should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.    - Childhood brain stem gliomas may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years.    - Some cancer treatments cause side effects months or years after treatment has ended.    - Six types of standard treatment are used:         - Surgery      - Radiation therapy      - Chemotherapy      - Cerebrospinal fluid diversion     - Observation     - Targeted therapy        - New types of treatment are being tested in clinical trials.     - Patients may want to think about taking part in a clinical trial.    - Patients can enter clinical trials before, during, or after starting their cancer treatment.    - Follow-up tests may be needed.
                
                
                    There are different types of treatment for children with brain stem glioma.
                    Different types of treatment are available for children with brain stem glioma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.    Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
                
                
                    Children with brain stem glioma should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.
                    Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:         -  Pediatrician.    -  Neurosurgeon.    -  Neuropathologist.    -  Radiation oncologist.    -  Neuro-oncologist.    -  Neurologist.    -  Rehabilitation specialist.    -  Neuroradiologist.    -  Endocrinologist.    -  Psychologist.
                
                
                    Childhood brain stem gliomas may cause signs or symptoms that begin before the cancer is diagnosed and continue for months or years.
                    Childhood brain stem gliomas may cause signs or symptoms that continue for months or years. Signs or symptoms caused by the tumor may begin before diagnosis. Signs or symptoms caused by treatment may begin during or right after treatment.
                
                
                    Some cancer treatments cause side effects months or years after treatment has ended.
                    These are called late effects. Late effects may include the following:         - Physical problems.    - Changes in mood, feelings, thinking, learning, or memory.    -  Second cancers (new types of cancer).        Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).
                
                
                    Six types of standard treatment are used:
                    Surgery      Surgery may be used to diagnose and treat childhood brain stem glioma as discussed in the General Information section of this summary.        Radiation therapy      Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:             -  External radiation therapy uses a machine outside the body to send radiation toward the cancer.     -  Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.             The way the radiation therapy is given depends on the type of the cancer being treated. External radiation therapy is used to treat DIPG. External and/or internal radiation therapy may be used to treat focal brain stem gliomas.     Several months after radiation therapy to the brain, imaging tests may show changes to the brain tissue. These changes may be caused by the radiation therapy or may mean the tumor is growing. It is important to be sure the tumor is growing before any more treatment is given.       Chemotherapy      Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type of the cancer being treated.     Because radiation therapy to the brain can affect growth and brain development in young children, clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.       Cerebrospinal fluid diversion     Cerebrospinal fluid diversion is a method used to drain fluid that has built up in the brain. A shunt (long, thin tube) is placed in a ventricle (fluid-filled space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries extra fluid away from the brain so it may be absorbed elsewhere in the body.          Observation     Observation is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change.       Targeted therapy     Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.     Some focal brain stem gliomas that cannot be removed by surgery may be treated with BRAF kinase inhibitor therapy. BRAF kinase inhibitors block the BRAF protein. BRAF proteins help control cell growth and may be mutated (changed) in some types of brain stem glioma. Blocking mutated BRAF kinase proteins may help keep cancer cells from growing.
                
                
                    New types of treatment are being tested in clinical trials.
                    Information about clinical trials is available from the NCI website.
                
                
                    Patients may want to think about taking part in a clinical trial.
                    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.   Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.   Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
                
                
                    Patients can enter clinical trials before, during, or after starting their cancer treatment.
                    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.   Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
                
                
                    Follow-up tests may be needed.
                    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.   Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.   If the results of imaging tests done after treatment show a mass in the brain, a biopsy may be done to find out if it is made up of dead tumor cells or if new cancer cells are growing. In children who are expected to live a long time, regular MRIs may be done to see if the cancer has come back.
                
                
						            Treatment Options for Childhood Brain Stem Glioma
						            
						                
						                    Newly Diagnosed Childhood Brain Stem Glioma
						                    Newly diagnosed childhood brain stem glioma is a tumor for which no treatment has been given. The child may have received drugs or treatment to relieve signs or symptoms caused by the tumor.       Standard treatment of diffuse intrinsic pontine glioma (DIPG) may include the following:            -  Radiation therapy.     -  Chemotherapy (in infants).               Standard treatment of focal glioma may include the following:            -  Surgery that may be followed by chemotherapy and/or radiation therapy.     -  Observation for small tumors that grow slowly. Cerebrospinal fluid diversion may be done when there is extra fluid in the brain.     -  Internal radiation therapy with radioactive seeds, with or without chemotherapy, when the tumor cannot be removed by surgery.     -  Targeted therapy with a BRAF kinase inhibitor, for certain tumors that cannot be removed by surgery.               Treatment of brain stem glioma in children with neurofibromatosis type 1 may be observation. The tumors are slow-growing in these children and may not need specific treatment for years.     Check the list of NCI-supported cancer clinical trials that are now accepting patients with untreated childhood brain stem glioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.
						                
						                
						                    Progressive or Recurrent Childhood Brain Stem Glioma
						                    When cancer does not get better with treatment or comes back, palliative care is an important part of the child's treatment plan. It includes physical, psychological, social, and spiritual support for the child and family. The goal of palliative care is to help control symptoms and give the child the best quality of life possible. Parents may not be sure about whether to continue treatment or what kind of treatment is best for their child. The healthcare team can give parents information to help them make these decisions.      There is no standard treatment for progressive or recurrent diffuse intrinsic pontine glioma. The child may be treated in a clinical trial of a new treatment.         Treatment of recurrent focal childhood brain stem glioma may include the following:            - A second surgery to remove the tumor.     -  External radiation therapy.     -  Chemotherapy.     - A clinical trial of a new treatment.            Check the list of NCI-supported cancer clinical trials that are now accepting patients with recurrent childhood brain stem glioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.