Pediatric Malignant Glioma
Pediatric malignant gliomas are tumors that occur in children. They are high-grade brain and spinal cord tumors. These gliomas form from glial cells in the central nervous system. In children, they tend to grow quickly. They are among the most challenging malignant brain tumors to treat.
Subtypes of gliomas
Common types of gliomas include:
Glioblastoma — a fast-growing brain tumor
Anaplastic astrocytoma — a cancer that grows from cells called astrocytes. These cells support and protect brain cells.
Diffuse midline glioma — a tumor that forms in the center of the brain or spinal cord
Less common tumor types include:
Embryonal tumors
Germ cell tumors
Choroid plexus tumors
Meningiomas
All of these are called central nervous system (CNS) tumors. The CNS includes the brain and spinal cord.
Your UF Health care team
UF Health's cancer care is designed around multidisciplinary, patient-centered care. Children diagnosed with malignant gliomas are cared for by a team of medical specialists:
Pediatric brain cancer doctors (neuro-oncologists)
Brain surgeons (neurosurgeons)
Radiation doctors (radiation oncologists)
Brain tissue experts (neuropathologists)
Brain imaging doctors (neuroradiologists)
Rehabilitation specialists
Social workers and supportive care experts
Research teams
These experts work together to plan the individualized, comprehensive treatment for each child.
A national leader in brain tumor care
The UF Health Cancer Institute is an NCI-designated cancer center. This means that families have access to more clinical trials than at any other center in Florida.
UF Health’s brain tumor program is part of the Preston A. Wells Jr. Center for Brain Tumor Therapy. Our pediatric brain tumor program is ranked among the nation’s best.
UF is an active member of major pediatric brain tumor consortia, including:
Pacific Pediatric Neuro-Oncology Consortium (PNOC)
Pediatric Brain Tumor Consortium (PBTC).
These partnerships give UF Health access to new treatments and research studies.
We offer a full spectrum of cancer treatment, from minimally invasive biopsies and surgical resection to advanced radiation techniques, systemic therapy and the latest immunotherapies. UF Health Shands Children’s Hospital provides comprehensive services:
Nursing
Occupational therapy
Physical therapy
Speech therapy
Social work
Child life
Symptoms
The symptoms of these tumors vary depending on the tumor type, location, size and rate of growth. The tumor's effect on nearby brain structures and nerves also impacts symptoms. A tumor can press on parts of the brain that control vision, movement, speech or balance.
Symptoms include:
Headaches that last all day or are worse in the morning
Nausea or vomiting
Changes in appetite or weight
New or worsening seizures
Weakness, numbness or coordination problems
Vision, speech or balance issues
Behavioral or school performance changes
These symptoms can progress rapidly if the tumor is aggressive.
Because children’s brains are developing, a tumor’s effects can sometimes be hard to detect. Symptoms may initially be mistaken for benign childhood brain or adolescent issues. It’s critical to pay close attention to worsening headaches or unexplained neurological changes. Family, teachers or doctors can notice and help with early detection.
Diagnostic evaluation
Doctors use several steps to find out if a child has a malignant glioma. The process of diagnosing these tumors begins with a:
Medical history and exam
The doctor asks about symptoms and when they began.
The doctor also checks the child’s movement, vision, speech and reflexes. This is called a neurological exam.
Imaging tests
Doctors use MRI scans (magnetic resonance imaging) to look inside the brain. An MRI uses magnets and radio waves to make detailed pictures. Sometimes a contrast dye helps show the tumor more clearly. MRI with and without contrast is the gold standard for evaluating suspected gliomas.
Advanced MRI tests may be ordered to characterize the abnormal cells. These tests may include:
Diffusion MRI — shows how water moves through brain tissue
Perfusion MRI — measures blood flow in the tumor
Spectroscopy — helps tell cancer cells from normal cells
If doctors think the tumor may spread through the spine, they may also order an MRI of the spine.
Resection and biopsy
When safe and feasible, neurosurgeons aim to perform surgical resection or biopsy. A biopsy allows your doctors to collect a sample of tissue for molecular and genetic testing. The sample is essential for confirming your diagnosis and prognosis. It can also determine your eligibility for targeted therapies or clinical trials.
Doctors test the tumor for:
Genetic changes (variants) that affect how the cancer grows
Epigenetic markers, which control how genes turn on or off
Methylation status, which can affect how tumors respond to treatment
Biomarkers, which help guide treatment decisions
Sometimes the tumor is located in deep or delicate regions of the brain. In these cases, stereotactic or minimally invasive biopsy approaches may be preferred.
Tumor board review
Each case is reviewed at UF Health by a brain tumor board. Specialists from several fields review the findings and propose a personalized treatment plan. UF ensures that these reviews are held for every patient.
Additional testing
Before treatment begins, additional baseline testing is done. In some cases, cerebrospinal fluid sampling (cytology) is considered. This is common when leptomeningeal disease is suspected in patients with primary brain tumors.
Treatment and therapeutic strategies
Treating pediatric malignant gliomas is complex. Because outcomes with conventional cancer treatment are poor, we use multiple different treatments. Our care team carefully balances these treatments to deliver effective care while minimizing long-term effects in developing children or young adults.
Surgery
When it is safe to do so, the first step is to remove as much of the tumor as possible surgically. This is called a resection. Removing as much of the tumor as possible helps reduce tumor burden and may improve the outcome.
However, gliomas are often diffuse and infiltrative. This makes a complete resection rare. In addition, the location of the tumor might make a partial resection safer. In some cases where cancer is recurrent, re-resection may be considered.
Radiation therapy
Radiation therapy uses strong energy beams to destroy cancer cells. It is one of the main treatments for malignant glioma. UF Health’s radiation oncology team leverages modern techniques, such as:
Intensity-modulated radiation therapy (IMRT) — shapes the radiation beam to match the tumor
Volumetric-modulated arc therapy (VMAT) — delivers radiation in a rotating arc around the head
Proton therapy — uses particles called protons to focus energy on the tumor and protect healthy tissue
These approaches deliver precise doses of radiation to affected cells. This minimizes radiation exposure to adjacent healthy brain tissue and nerves.
Because radiation in children carries risks of long-term side effects, the radiation regimens are carefully managed. They're tailored by pediatric experts from numerous fields who work together. In very young children, radiation may need to be delayed or modified. In specific aggressive settings, shorter, higher dose-per-fraction schedules may be considered.
Chemotherapy, targeted agents and systemic therapy
Chemotherapy is often given together or in succession with radiation. Chemotherapy uses medicine to kill cancer cells or stop them from growing.
Doctors often use it after surgery or during radiation therapy.
Temozolomide is frequently used.
Other drugs may be added depending on the tumor type or genetic features.
If genetic alterations are found, targeted therapies may be used. Targeted therapy focuses on tumors with certain genetic changes.
Systemic therapy
Systemic therapy travels through the bloodstream to reach cancer cells throughout the body. This can include:
Targeted drugs
Immunotherapy
Experimental therapies in clinical trials
Clinical trials
Traditional cancer treatment often fails to cure pediatric malignant glioma. Because of this, UF Health strongly encourages enrollment in clinical trials. Trials test new treatments to find better ways to stop tumor growth.
New treatments may include:
Small-molecule inhibitors that block cancer signals
Antibody-drug conjugates that attach to tumor cells
Biologic therapies that use the immune system to fight cancer
Immunotherapy and experimental therapies
UF Health is a leader in using immunotherapy to treat pediatric and adult brain tumors. Immunotherapy uses the body’s own immune system to find and destroy cancer cells. The UF Brain Tumor Immunotherapy Program, led by investigators like Dr. Duane Mitchell, develops approaches to enhance immune responses against cancer cells.
UF’s immunotherapy programs include:
CAR T-cell therapy – lab-modified immune cells that attack tumor cells
T-cell receptor therapy – engineered T-cells that recognize cancer cells
Cancer vaccines – treatments that teach the immune system to target cancer
Oncolytic viral therapy – viruses designed to infect and destroy cancer cells
One promising route is the development of RNA-loaded nanoparticle vaccines. UF researchers, such as Dr. Elias Sayour, lead efforts to engineer nanocarriers. These vehicles deliver tumor-specific RNA payloads to redirect the immune system to recognize and attack cancer cells. Early-phase trials combining standard therapies with immunologic approaches are ongoing.
UF is part of major pediatric tumor consortia (PNOC, PBTC) and is an NCI-designated cancer center. Because of this, many first-in-human and early-phase clinical trials are available to UF patients.
Outcomes and risks
Despite aggressive multimodal cancer treatment, pediatric malignant gliomas remain difficult to cure. Survival depends heavily on:
Tumor type
Molecular features
Child age
Residual tumor burden
Cancer treatment can impact children in a variety of ways:
Growth
Hormone imbalances
Hearing changes
Vision changes
Learning and memory difficulties
Emotional or psychological effects
Supportive and adjunctive care
Throughout treatment, supportive care is essential. Steroids are used to reduce swelling and intracranial pressure. Anti-seizure medications are used when seizures occur or are at risk.
Rehabilitation
Rehabilitation services are essential to help children maintain function and quality of life. These include:
Physical therapy for strength and movement
Occupational therapy for daily tasks
Speech therapy
Neurocognitive support for thinking and learning skills
Long-term monitoring (survivorship care)
Children need long-term follow-ups by experts in various fields and supportive care teams. Survivorship care is essential to:
Monitor and manage late effects
Provide educational support
Address emotional and psychosocial needs
UF Health places special emphasis on:
Neurocognitive rehabilitation to help with thinking and memory
Endocrine monitoring to check hormones and growth
Educational support for school performance
Psychological care for emotional health
Late effects screening for lasting treatment issues
Survivorship care helps each child live a healthy and independent life after cancer treatment.
Patient and family support
UF Health offers services to help families with emotional, practical and financial challenges. The brain tumor therapy program offers pediatric patient resources, including:
Lodging support
Transportation assistance
Guidance for navigating medical leave and disability
UF Health works with groups like the Ronald McDonald House in Gainesville. These groups give temporary housing to families during treatment.
Social work support
Pediatric oncology social workers help with:
Stress and coping
Appointment planning
Insurance and financial questions