Glioblastoma multiforme and anaplastic astrocytoma

We know how difficult a diagnosis of a pediatric brain tumor can be, both for your child and for your whole family. That’s why Boston Children's Hospital physicians focus on family-centered care: From your first visit, you’ll work with a team of professionals who are committed to supporting all of your family’s physical and psychosocial needs. We’ll work with you to create a care plan that’s best for your child. 

There are a number of treatments we may recommend. Some of them help to treat the tumor, while others address complications of the disease or side effects of the treatment.

The primary treatment for newly diagnosed glioblastoma multiforme and anaplastic astrocytoma includes maximal surgical removal, when possible, followed by radiation therapy. To date, no chemotherapy regimen has been demonstrated to increase survival rates in children with pediatric high-grade gliomas.

As with all pediatric cancers, we recommend that care be delivered at specialized centers like ours. Here, multidisciplinary teams can provide expert diagnostics and treatment by experienced medical, surgical and radiation oncologists. Also, they can make sure your child has psychosocial support, neuro-psychological testing and specialized school plans.

Treatment may include (alone or in combination):

Surgery

The first treatment is usually surgery to remove as much of the tumor as possible. Our pediatric neurosurgeons are experienced at using advanced techniques, such as intraoperative MRI, to maximize removal of the tumor.

• Surgery has multiple roles in the management of glioblastoma multiforme and anaplastic astrocytoma, including treatment of increased intracranial pressure, biopsy and tumor removal.
   
• Tumor specimens are examined by our pediatric neuropathologists to determine the exact diagnosis.
   
• Complete resection or surgical removal of the entire tumor is ideal when possible.
  • Most high-grade gliomas cannot be completely removed because they tend to infiltrate into adjacent healthy tissues.
  • Tumors of the cerebral hemispheres are generally easier to remove than those along the midline of the brain.
     
• A biopsy of the removed tissue is conducted for diagnostic purposes.
   
• In general, the more completely the tumor can be removed, the greater the chances for survival.

The infiltrating nature of these tumors makes removal difficult. Technological advances, such as the intra-operative MRI, where surgeons can visualize the tumor as they operate with MRI scans, can enhance efforts at resection for difficult tumors and thereby improve survival.

Radiation therapy

Your child may also receive precisely targeted and dosed radiation in order to kill cancer cells left behind after surgery. This is important to control the local growth of tumor, and it helps increase survival in high-grade gliomas.

• Radiosurgery to deliver additional radiation to residual tumor masses is also being used in specific cases.
• Other techniques to increase radiation dose have been unable to enhance survival over conventional radiotherapy.

Chemotherapy

Chemotherapy refers to drugs that interfere with the cancer cells' ability to grow or reproduce. For glioblastoma multiforme and anaplastic astrocytoma, chemotherapy before surgery may help shrink the tumor, making it possible to remove.

• Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
• Often, we use a combination of chemotherapy drugs.
• We may give certain chemotherapy drugs in a specific order.
• A variety of chemotherapy regimens have been tested in the treatment of newly diagnosed high-grade gliomas.
• While studies in adults have suggested that certain drugs can produce modest responses in high-grade gliomas, this effect has been less pronounced for pediatric patients.
• Several regimens have produced responses, but none has improved survival.
• Increased doses of chemotherapy along with autologous stem cell transplant have also not produced notable advantage.
• New biologic and immunotherapy-based treatments for newly diagnosed glioblastoma multiforme and anaplastic astrocytoma are now being tested to try to improve the effectiveness of therapy.

Chemotherapy drugs do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.

Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:

• orally, as a pill to swallow
• intramuscularly, as an injection into the muscle or fat tissue
• intravenously, directly to the bloodstream
• intrathecally, directly into the spinal fluid with a needle

How are side effects managed?

Side effects in the treatment of glioblastoma multiforme and anaplastic astrocytoma can arise from surgery, radiation and chemotherapy.

• Procedures should be performed in specialized centers where experienced neurosurgeons, working in the most technologically advanced settings, can provide the most extensive resections while preserving normal brain tissue.
   
• Radiation therapy often produces inflammation, which can temporarily exacerbate symptoms and dysfunction. To control this, inflammation steroids are sometimes necessary.
   
• Some of the chemotherapy agents are associated with fatigue, diarrhea, constipation and headache. These side effects can be effectively managed under most circumstances with standard medical approaches.

Many specialized brain tumor treatment centers now have specialists who deliver complementary or alternative medicines. These treatments, which may help control pain and side effects of therapy, include the following.

• acupuncture/acupressure
• therapeutic touch
• massage
• herbs
• dietary recommendations

Talk to your child’s physician about whether complementary or alternative medicine might be a viable option.

What is the expected outcome after treatment for glioblastoma multiforme or anaplastic astrocytoma?

Unfortunately, the prognosis for glioblastoma multiforme and anaplastic astrocytoma tumors remains very poor. In general, more complete removal of tumors, when possible, results in a greater chance of survival. Your child’s physician will discuss treatment options with you, including experimental clinical trials, and supportive care.

What about progressive or recurrent disease?

For children with relapsed high-grade gliomas, we offer access to the latest clinical trials and experimental therapies. Current trials include novel medications as well as new methods for the delivery of more traditional agents. Talk to your child’s physician for more information about clinical trials and experimental treatments.

Resources and support

We understand that you may have a lot of questions if your child is diagnosed with a glioblastoma multiforme or an anaplastic astrocytoma. Will it affect my child long-term? What do we do next? We’ve tried to provide some answers to those questions in these pages, but there are also a number of resources and support services to help you and your family through this difficult time.