Treatment Options for Solid Tumors at Siteman Kids
Patients at Siteman Kids are treated by WashU Medicine physicians. They are experts who provide excellent care to children at St. Louis Children’s Hospital while also working hard in a laboratory setting to learn more about disease and discover new ways to treat it. Because many Siteman Kids physicians are researching the biology of tumors and how they act in the body, they are able to administer research-based clinical care, thoughtfully considering the individual child and what they may need rather than rigidly following the protocols of a pre-determined treatment plan.
Every child with cancer is different, and every treatment plan for a child with a tumor is unique. There are many considerations for how to treat a tumor, including your child’s overall health, the kind of tumor, the tumor’s location, its size, genetic factors, if there are multiple tumors and more. It is common for a treatment plan to combine different interventions at once or use them in stages.
Many of the treatment options offered at Siteman Kids are not available everywhere. WashU Medicine physicians have pioneered the use of specific technology and treatments, like Proton Beam Therapy and Gamma Knife Radiosurgery, with pediatric patients. This allows our young patients access to cutting-edge interventions. After learning about their specific case, your child’s physician may recommend one or more of the following treatments:
Brachytherapy is a form of precision therapy where a capsule about the size of a grain of rice containing radiation is implanted directly into the tumor. The tumor is exposed to radiation from the inside, killing the cancer cells while not exposing healthy tissues.
There are three kinds of brachytherapy used for pediatric patients: low dose, high dose and permanent. A benefit of brachytherapy is its precision. Where the implant is placed, the strength of the radiation inside the capsule, and the length of time it remains in the tumor are all adjusted specifically for the patient’s needs and how the tumor has responded to treatment.
Chemotherapy is a medicine that attacks cancer cells. It stops cancer cells from growing and reproducing and can reduce the tumor’s size. Chemotherapy (or chemo) may be given through a vein (IV) or spinal canal, injected into a muscle or deep tissue, or taken by mouth. There are several medicines that make up chemotherapy, and they are often given at different times. Treatment can have side effects and can be hard on the body, so it is usually done in cycles, with rest periods in between. This gives your child time to recover.
Cryotherapy is a tool that administers a cold substance, like nitrogen, to the tumor site. This freezes the cancer cells, making them unable to create new cancer cells and killing them.
Another approach to chemotherapy can take place alongside a stem cell transplant. First, young blood cells, called stem cells, are taken from the child or from a donor. Then, high doses of chemotherapy medicine can be administered, eliminating cancer cells remaining in the body. After chemotherapy, the stem cells are replaced, rejuvenating the child’s immune system.
Hyperthermic Intraperitoneal Chemotherapy, or HIPEC, is a highly specialized treatment where chemotherapy is heated to maximize its effectiveness in killing cancer cells for tumors located in and around the reproductive organs and abdomen. The chemotherapy dosage is high and localized, circulating in the abdomen for about 90 minutes. The whole procedure takes place in three stages with goals to shrink the size of tumors, surgically remove them, and kill those cancer cells that are undetectable at the time of the procedure.
Intraoperative MRI is a treatment that uses magnetic resonance imaging (MRI) to view the brain during surgery. This clear imaging allows surgeons a precise view of the tumor as they work to remove it from the healthy tissue. This ability to see the tumor can reduce the number of surgeries needed to remove all of the cancer cells. Siteman Kids is one of a very few facilities in the nation that are equipped with this technology.
Intra-arterial chemotherapy (IAC) is a therapy used to treat retinoblastomas. The procedure uses a tiny catheter to deliver chemotherapy right into the eye at tumor sites. Because chemotherapy in IAC is used in a localized, precise way, it can help avoid surgery to remove the eye. Siteman Kids is one of approximately 20 programs in the nation that perform IAC and is the only pediatric cancer center in Missouri or Kansas where it is available.
Immunotherapy uses the body’s immune system to fight cancer cells, or it uses antibodies to kill cancer cells. Immunotherapies come in many different forms, but the common thread is that the immune system can help kill leukemia cells that are otherwise resistant to chemotherapy.
An organ transplant is a surgical procedure or procedures where an organ is removed and then replaced with a healthy donor’s organ, or in some cases, part of an organ. The pediatric organ transplant teams at St. Louis Children’s hospital most often conduct kidney, liver and lung transplants for pediatric cancer patients. Siteman Kids specializes in pre- and post-surgical care as well as innovative transplant techniques. Our transplant teams are experienced in lung lobe implantations and trimmed liver transplants, procedures that allow patients to receive lifesaving care sooner than waiting for a whole organ match.
St. Louis Children’s Hospital has a dedicated, lead-lined room and adjoining suite specifically to administer MIGB therapy. MIGB therapy is an investigational radiation drug The adjoining suite allows families to be close to their child during and after the treatment.
Proton Beam Therapy uses a different form of radiation, proton particles, to destroy cancer cells. Proton particles act differently than other forms of radiation, so they are able to be used in patients in higher doses. The proton beam sends radiation to highly specific areas, concentrating on the tumor and minimizing the healthy tissue’s exposure to it.
Radiation therapy uses high-energy X-rays or other types of radiation to target cancer cells. The radiation itself changes the cancer cells’ ability to grow and damages them so they cannot reproduce. There are many different ways to administer radiation that are precise and limit exposure to the whole body. Radiation can be applied to a targeted location in the brain so that other areas are not impacted.
Surgery is often the first intervention used with pediatric brain tumors. As much of the tumor is surgically removed as possible.
Targeted therapy is a cutting-edge form of precision medicine that uses drugs to single out mutations or antibodies that are specific to how leukemia is created and spreads in the body. In some cases, the mutations that cause leukemia also make it vulnerable to specific drugs that have only limited effects on normal cells. This means that healthy cells have limited contact with the medicine, so they remain unharmed. Some of these medical therapies can be used in combination with chemotherapy.
Thermotherapy uses a laser to destroy cancer cells. This may be used for some small tumors, or it may be used in combination with chemotherapy or radiation for larger tumors.
Clinical trials are research studies designed to give patients access to innovative treatments before they are available everywhere while providing valuable information about treating pediatric cancers. Clinical trials for children often take place at multiple locations across the nation. Siteman Kids is proud to lead some of these research efforts.
It is important to note that your child’s well-being is a priority during diagnostic testing. Our care team tries to ease any fears or pain a patient has during testing. If needed, we can use light sedation to limit stress and help children feel more comfortable for more involved procedures.
Nurses at Siteman answer every call and every form. Speak with them directly 8:00 am to 4:30 pm CT Monday- Friday for guidance on appointments, second opinions, and referrals.
