Medical Health Encyclopedia

Surgery, if possible, plus radiotherapy. Surgery alone in certain children, if possible. Trials on postoperative radiotherapy include the following: Radiotherapy with or without chemotherapy; Low-versus-high radiotherapy doses (studies suggest results are the same and high-dose causes more side effects); Deferring radiotherapy until tumor progresses and symptoms occur. (A major 2002 study confirmed earlier ones that suggest that this approach has the same 5-year survival benefits--about 65%--as immediate postoperative radiotherapy.)

Malignant (High-grade III and IV) Astrocytomas. Anaplastic astrocytoma (gemistocytic and some pleomorphic xanthoastrocytomas). Usually mid-grade (III).

Tumors grow more rapidly than lower grades and infiltrate other nearby healthy cells. Not well-differentiated. Five-year survival rates are about 30%. Recurrence is common.

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Treatment same for all high-grade malignant astrocytomas.

Surgery, with removal of as much of tumor as possible followed by radiotherapy, with or without chemotherapy.

The addition of chemotherapy, particularly being able to take more than 6 cycles, appears to improve survival rates. Carmustine (BCNU) most effective agent at this time. Other agents and treatment sequences are under investigation. For example, temozolomide is showing promise for many patients, including the elderly. Topotecan may also be useful with other agents or with radiation.

For recurring gliomas, surgery with placement of wafers that release carmustine (Gliadel wafers) is the only proven beneficial therapy to date. Combinations, such as procarbazine and carmustine, provide benefits for recurrent anaplastic astrocytomas. Single agents may be less toxic and as helpful for other recurrent gliomas. Temozolomide has been approved in Europe for high-grade recurrent gliomas and is proving to be beneficial. Other trials include the following: drugs that block small molecules involved in tumor growth; radioimmunotherapy using monoclonal antibodies; advanced radiotherapy techniques; intraarterial chemotherapy.