High-Grade Glioma Treatment

High-grade glioma (HGG) is a broad term used to describe a group of very aggressive tumors that occur in the brain and spine. HGGs are fast-growing and difficult to treat. Altogether, they are one of the most common brain cancers in children and make up about 20% of all diagnosed pediatric brain tumors.

Although the prognosis for these tumors is poor, and the survival low, we, at St. Jude Children’s Research Hospital, are committed to improving these outcomes.

Types of high-grade gliomas

HGG are called many different names, depending on where they are in the brain or spine, the tumor features, and the types of molecular or genetic changes (mutations) that caused the tumor to develop.

Because there are many different types of HGG, molecular testing must occur on your tumor before you can get a correct diagnosis. Types of HGG include:

Adult-type diffuse glioma
Anaplastic astrocytoma
Anaplastic oligodendroglioma
Astrocytoma, IDH mutant, grade 3 or grade 4
Brainstem glioma
Diffuse hemispheric glioma, H3 G34-mutant
Diffuse intrinsic pontine glioma (DIPG)
Diffuse midline glioma, H3 K27M-mutant
Diffuse pediatric-type high grade glioma, H3 wildtype and IDH wildtype
Diffuse pediatric-type high grade glioma, NOS
Giant cell glioblastoma
Glioblastoma
Gliomatosis cerebri
Infant-type hemispheric glioma
Pleomorphic xanthoastrocytoma
Oligodendroglioma

High-grade glioma causes

Some recognized risk factors for high-grade glioma include:

Radiation exposure
Diagnosis of genetic conditions such as Li-Fraumeni syndrome
Family history of high-grade glioma

But most of these tumors come about by chance. There does not seem to be any environmental or genetic reason.

Treatment of high-grade glioma

The most common treatment modalities are surgery, radiation therapy, targeted therapy, and occasionally chemotherapy.

Treatment for patients diagnosed with high-grade glioma can include:

Surgery to remove all or part of the tumor and diagnose the tumor type. Because patients generally do better if more of the tumor is safely removed, then this is the first goal of surgery. But almost all patients with high-grade glioma will need more treatment. Complete surgical removal of these invasive tumors is often not possible.
Radiation therapy using high-energy x-rays and other types of radiation to kill tumor cells and stop them from growing
Targeted therapies, which are generally newer medicines designed specifically to target cancer cells.
Chemotherapy has not been very effective in the management of high-grade glioma. Your oncologist will discuss with you if there is a good reason to try traditional chemotherapy with your tumor.

Your child’s care team may also prescribe medicines to help control symptoms and improve quality of life during treatment.

High-grade glioma clinical trials

High-grade glioma patients take part in clinical trials that use the most advanced diagnosis tools and treatments available. Our goal is to give each child the best treatment with the lowest number of side effects.

Our doctors and scientists work together to find better ways to treat patients. In many cases, new treatments are being developed right here on the St. Jude campus.

We also take part in trials developed by the Children’s Oncology Group (COG) and the Pediatric Brain Tumor Consortium (PBTC). Many St. Jude staff members play key roles in developing these studies. They are large studies carried out at multiple centers across the United States. 

Learn more about clinical research at St. Jude.

Recruiting

PBTC45: MK-3475 in Treating Children with Recurrent, Progressive or Refractory HGGs, DIPGs and Hypermutated Brain Tumors

Study goal:

To study the side effects and best dose of MK-3475 (pembrolizumab) and to see how well it works in treating younger patients with high-grade gliomas (brain tumors), diffuse intrinsic pontine gliomas (brain stem tumors), or hypermutated brain tumors that have come back, progressed or have not responded to previous treatment

Age:

Participant is 1 to 18 years of age

Recruiting

PBTC48: Optune Device in Children with Certain High-Grade Glioma or Ependymoma Brain Tumors

Study goal:

The main purpose of this study is to see if the Optune System is safe to use in children. Researchers also want to find out if children are able to wear the device as instructed.

Age:

Between 5 and 21 years old

Recruiting

PBTC49: Phase 1 Trial of Savolitinib in Recurrent, Progressive or Refractory Medulloblastoma, High-Grade Glioma, or Diffuse Intrinsic Pontine Glioma

Study goal:

To see if savolitinib is safe and tolerable in children with brain tumors

Age:

Between 5 years old and 21 years old

High-grade glioma care at St. Jude

St. Jude provides the highest quality of care for patients with high-grade glioma:

We bring together medical experts and specially trained staff to care for your child. We also work with brain surgeons (neurosurgeons) at Le Bonheur Children’s Hospital.
We have a special team that helps understand the makeup of the tumor. This team includes doctors and scientists who study:
- Cancer cells
- How the cancer happened
- Current medicines and treatments to kill cancer cells
- What makes cancer cells grow and what new medicines can stop them
- New medicines and other therapies to improve how treatments work
Our brain tumor clinical trials have led to better therapies in children. These improvements include lower-dose therapies, targeted therapy, and proton therapy. These treatments kill cancer cells while sparing healthy cells and may lessen the severity of side effects that affect brain function after treatment for some types of brain tumors.
The St. Jude Proton Therapy Center is the first center in the world that treats only children with this therapy.
Along with the treatment studies constantly being developed at St. Jude, the staff also treats patients on studies developed by the Children’s Oncology Group, the Pediatric Brain Tumor Consortium, and the Pacific Pediatric Neuro-Oncology Consortium. Many St. Jude staff members play key roles in developing these studies. They are large trials carried out at multiple centers across the United States.
St. Jude offers a dedicated team of specialists to meet the needs of children with brain tumors, including:
- Surgeons, doctors, and nurses who treat this cancer
- Doctors who specialize in radiation therapy and pathology (making a diagnosis by looking at tumor tissue under the microscope)
- Experts in diagnostic imaging and nuclear medicine
- Genetic counselors
- Clinical dietitians
- Child life specialists
- Psychologists
- Researchers and scientists

More reasons to choose St. Jude for care include:

We are consistently ranked among the best childhood cancer centers in the nation by US News & World Report.
At St. Jude, we have created an environment where children can be children and families can be together.
We lead more clinical trials for childhood cancer than any other hospital in the U.S. 
St. Jude is the only National Cancer Institute–designated Comprehensive Cancer Center just for children. A Comprehensive Cancer Center meets rigorous standards for research that develops new and better approaches to prevent, diagnose, and treat cancer.
The nurse-to-patient ratio at St. Jude is about 1:3 in hematology and oncology and 1:1 in the Intensive Care Unit.
Patients may be able to get expert, compassionate care and treatment closer to their homes through our St. Jude Affiliate clinics.

Get more information about the Brain Tumor Treatment program at St. Jude.

A statue of children running and holding hands

Seeking treatment at St. Jude

Patients accepted to St. Jude must have a disease we treat and must be referred by a physician or other qualified medical professional. We accept most patients based on their ability to enroll in an open clinical trial.

How to seek treatment

Contact us

You can start the referral process by letting your physician know you would like a second opinion from St. Jude. They can contact our 24-hour beeper service or contact our Brain Tumor Coordinator. You may also contact the brain tumor coordinator directly with questions.

Learn more about the types of brain tumors we treat at St. Jude, and our brain tumor eligibility requirements.