What are the treatments for an anaplastic astrocytoma?
The primary treatment for newly diagnosed anaplastic astrocytoma is maximal surgical removal, when possible, followed by radiation therapy. To date, no chemotherapy regimen has been demonstrated to increase survival in pediatric high-grade gliomas.
As with all pediatric cancers, care should be delivered at a specialized center where multidisciplinary teams can provide not only expert diagnostics and experienced medical, surgical and radiation oncologists, but also psychosocial support, neuro-psychological testing and specialized school plans all delivered in a child- and family-sensitive and friendly environment.
Treatment may include (alone or in combination):
Surgery has multiple roles in the management of anaplastic astrocytomas, including:
- treatment of increased intracranial pressure
- tumor removal
For operable tumors, the extent of surgical removal is related to prognosis. Most high-grade gliomas cannot be completely removed because of the way their cells infiltrate other tissue. However, multiple studies have demonstrated that maximal removal results in greater survival.
Tumors of the cerebral hemispheres are in general more easily removed than those of the midline, diencephalic structures.
Near complete resection of anaplastic astrocytoma in combination with radiation therapy has been reported to produce a five-year survival rate as high as 40 percent, whereas incompletely removed tumors were associated with a 20 percent five-year survival rate.
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 of difficult tumors and thereby improve survival.
Radiation therapy uses high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.
Chemotherapy is a drug that interferes with the cancer cell's ability to grow or reproduce.
Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors. Often, a combination of chemotherapy drugs is used. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.
While chemotherapy can effectively treat certain cancers, the drugs do not differentiate normal healthy cells from cancer cells. This means there can be many adverse side effects. 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.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
- as a pill to swallow
- as an injection into the muscle or fat tissue
- Intravenously, directly to the bloodstream (also called IV)
- Intrathecally, which means directly delivering the chemotherapy into the spinal column with a needle
How are side effects managed?
Side effects in the treatment of 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 have now specialists who deliver complementary or alternative medicines. These treatments, which may help control pain and side effects of therapy include the following.
- therapeutic touch
- dietary recommendations
What is the expected outcome after treatment for anaplastic astrocytoma?
The best reported survival rates for radically removed tumors treated with radiation therapy approaches 40 percent at five years. This is a minority of patients, however, and in most cases, the tumor cannot be completely removed. The five-year survival rates for children whose tumors are incompletely removed remains less than 20 percent. More complete removal of hemispheric tumors may be associated with greater survival.
What about progressive or recurrent disease?
Clinical trials and experimental therapies are available for patients with relapsed high-grade gliomas at specialized centers. Current trials include novel medications as well as new methods for the delivery of more traditional agents.
What is the recommended long-term care for children treated for an anaplastic astrocytoma?
Children treated for an anaplastic astrocytoma should visit a survivorship clinic every year to:
- manage disease complications
- screen for early recurrence of tumor
- manage late effects of treatment
A typical follow-up visit may include some or all of the following:
- a physical exam
- laboratory testing
- imaging scans
Through the Stop and Shop Family Pediatric Neuro-Oncology Outcomes Clinic at Dana-Farber Cancer Institute, children are able to meet with their neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit.
Endocrinologists, neuro-psychologists, alternative/complementary therapy specialists, and school liaison and psychosocial personnel from the pediatric brain tumor team are also available.
In addition, children needing rehabilitation may meet with speech, physical, and occupational therapists during and after treatments.