Brain cancer: tackling medulloblastoma, the most common, malignant, childhood brain tumour

Research Training Fellowship - Dr Rebecca Hill

Brain cancer: tackling medulloblastoma, the most common, malignant, childhood brain tumour ^1,2,3

Each year, Action Medical Research awards these prestigious grants to help the brightest and best doctors and scientists develop their career in medical research. Dr Hill’s grant of £204,861 will fund her three-year study into brain tumours that mostly affect children, with the longer term aim of protecting children from relapse and saving their lives.

Introduction

Around one in every ten children who die from cancer in the UK has a brain tumour called medulloblastoma.³ After first diagnosis, a gruelling treatment regime can save children’s lives. Sadly, though, around 30 to 40 per cent of treated children go on to face the devastating news that their disease has relapsed.^4,5 Most of these children die.^4,5

Dr Rebecca Hill is determined to help improve the chances of children with medulloblastoma, by searching for ways to prevent relapse and working towards better treatments.

“Through Action Medical Research’s funding, our group is now able to advance our understanding of relapsed medulloblastoma and improve the lives of children with this devastating diagnosis.” Dr Rebecca Hill

What's the problem and who does it affect?

Devastating brain tumours in children

Each year in the UK, around 100 children are diagnosed with a brain tumour called medulloblastoma.² Most are younger than ten years old.

“Almost all children who are diagnosed with medulloblastoma undergo intensive treatment for eight to 12 months, which consists of surgery, radiotherapy and chemotherapy,” explains Dr Hill. “Treatment interferes hugely with normal life, including school. At best, children must visit hospital once a week, but during radiotherapy it is every day.”

Treatment can bring side effects and leave surviving children with long-term health problems. “Toxicities of treatment can cause nausea, vomiting and nutritional problems,” says Dr Hill. “Children who survive can be left with learning disabilities and problems with growth, development and hormones, to name but a few.”

Sadly, despite undergoing this gruelling treatment regime, around 30 to 40 per cent of children go on to face the devastating news that their cancer has relapsed.^4,5 The outlook then is bleak. “The overwhelming majority – more than 90 per cent – of children with relapsed disease go on to lose their lives,” explains Dr Hill.^4,5 “Most treatments for relapsed disease can only prolong life - they are not a cure.”

What is the project trying to achieve?

What puts children at risk of relapse?

Dr Hill is studying how the illness of 50 children who developed relapsed medulloblastoma progressed. She is analysing around 50 paired samples of tumour tissue, which were taken when the children were first diagnosed with a brain tumour and again when their disease relapsed.

Dr Hill believes her study is the largest of its kind: “In the past, tumour biopsies have not been taken routinely from children with relapsed disease. It is the first time such a large group of samples, taken from children at initial diagnosis and then again at relapse, has been gathered together. It is vital to study the characteristics of these tumours if we are to improve children’s chances.”

Dr Hill is looking for ways to predict which children are at greatest risk of suffering a relapse. She is investigating whether any particular features of tumours are linked to relapse and whether those features are also present at initial diagnosis. Features that are under investigation include what the tumour looks like when viewed under a microscope, its genetic make-up and clinical features such as the child’s age at diagnosis, time to relapse and the type of treatment they received.

What are the researcher's credentials?

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Dr Hill is a talented young doctor. Inspired by the bravery of young patients on a children’s cancer ward, she decided to specialise in this area of medicine and gain the technical skills needed to succeed in research. “The families I have come into contact with are amazing at adapting to the stresses and strains of coping with cancer. Receiving this Fellowship from Action Medical Research is a huge honour,” says Dr Hill.

Dr Hill has joined a research group headed by Professor Steven Clifford, which is internationally recognised for its research into childhood brain tumours. The group aims to improve understanding of how children’s brain tumours develop, with the longer-term goal of finding ways to tackle brain tumours and improve children’s chances. 

“The Clifford group is ideally placed to host this vital research,” says Dr Hill. “It is very exciting to be awarded this Fellowship. It will enable me to complete a research project that I am extremely committed to, having witnessed first-hand the devastation that a diagnosis of medulloblastoma brings to both children and their families. I am encouraged by the provisional results we have achieved and am very hopeful for the future.”

Who stands to benefit from this research and how?

Tackling brain cancer

“Ultimately, this project aims to improve the lives of children who develop medulloblastoma, a devastating type of brain tumour,” explains Dr Hill. She hopes to reveal features of the children’s tumours that put them at risk of suffering a relapse.

Dr Hill’s work could lead to ways to identify children who are at high risk of suffering a relapse. If these children could be identified as soon as their tumour is first diagnosed, then they could be offered more intensive treatment right from the beginning. This might reduce the children’s chances of suffering a relapse and perhaps even save their lives.

Dr Hill’s work could also guide the development of new treatments for children who do suffer a relapse, with the aim of prolonging their lives or potentially curing their disease. New treatments might work by targeting features of the tumours that are linked to relapse.

“Relapsed medulloblastoma is one of the largest contributors to childhood cancer deaths in the UK, but it is poorly understood,” says Dr Hill. “Very little research has been carried out in the relapsed setting. It is very exciting to be helping to redress that balance and progress our understanding of relapsed disease.”

References

1. Medline Plus [Accessed 28 April 2011] http://www.nlm.nih.gov/medlineplus/ency/article/000768.htm
2. CancerStats: Childhood Cancer – Great Britain & UK, November 2010 [Accessed April 28 2011] http://publications.cancerresearchuk.org/WebRoot/crukstoredb/CRUK_PDFs/C...
3. Pizer B and Clifford S. The potential impact of tumour biology on improved clinical practice for medulloblastoma: progress towards biologically driven clinical trials. British Journal of Neurosurgery 2009; 23 (4): 364-375.
4. Pizer B and Clifford S. Medulloblastoma: new insights into biology and treatment. Arch Dis Child 2008; 93: 137-44.
5. Korshunov et al. Accumulation of genomic abberations during clinical progression of medulloblastoma (2008). Acta Neuropathol. 116: 383-90.