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Astrocytoma

Low–grade astrocytoma

Anaplastic astrocytoma

Glioblastoma multiforme

Brain stem glioma

Supportive therapy

Clinical trials

 

Glioma is a general term for a group of tumours that start in the supportive tissues (glial cells) of the brain or spinal cord. They are the most common type of primary brain tumours in adults and account for about 70% of all malignant (high-grade) tumours of the central nervous system (CNS).

 

The majority of gliomas are astrocytomas. Astrocytomas develop from a type of glial cell called an astrocyte (a star-shaped cell that surrounds, supports and protects neurons). They can occur in the brain, brain stem or the spinal cord.

 

Based on the WHO grading system, astrocytomas may be classified as low to high grade (grades I through IV).

 

The types of treatments given are based on the unique needs of the person with cancer.

Low-grade astrocytomas

Low-grade astrocytomas include both grade I and II tumours.

Pilocytic astrocytoma

Pilocytic astrocytomas are grade I tumours. They tend to grow slowly and often contain cysts. They are most common in children and young adults. People with neurofibromatosis have an increased risk for pilocytic astrocytoma.

Diffuse or infiltrating astrocytoma

Diffuse or infiltrating astrocytomas are grade II tumours. They tend to grow slowly, invade nearby brain structures and have the potential to become malignant (cancerous).They typically affect young adults. People with Li-Fraumeni syndrome have an increased risk for diffuse astrocytomas.

 

Types of diffuse astrocytomas include:

  • fibrillary
  • gemistocytic
  • protoplasmic

Treatment of low-grade astrocytomas

The following are treatment options for low-grade astrocytomas.

  • active surveillance
    • MRI is commonly used to track low-grade astrocytomas.
  • surgery
    • Surgery may be used to obtain a biopsy and confirm a diagnosis.
    • It may be used as the main treatment to remove all of the tumour or as much of the tumour as possible.
    • Surgery may be used to treat recurrent tumours.
  • radiation therapy
    • External beam radiation therapy may be used:
      • if the doctor knows or suspects some tumour remains after surgery
      • as the main treatment if surgery is not an option
      • to treat recurrent tumours if radiation therapy was not given previously

 

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Anaplastic astrocytoma

Anaplastic astrocytomas (also called malignant astrocytomas) are grade III tumours. The average age at diagnosis is 41 years.

  • The cells in these tumours are abnormal in appearance and the tumours grow quickly.
  • A low-grade astrocytoma may progress to an anaplastic astrocytoma.
  • Anaplastic astrocytomas tend to progress to a glioblastoma multiforme.

Treatment of anaplastic astrocytomas

The following are treatment options for anaplastic astrocytoma:

  • surgery
    • If surgery can be done, it is used as the first treatment to remove as much of the tumour as possible.
    • Surgery is followed by radiation therapy, with or without chemotherapy.
  • radiation therapy
    • External beam radiation therapy is used following surgery, with or without chemotherapy.
    • It may also be given as the main treatment if surgery is not an option.
  • chemotherapy
    • Chemotherapy may be used with radiation therapy following surgery.
    • It may also be used to treat recurrent anaplastic astrocytoma.
    • The most common single agent chemotherapy used to treat anaplastic astrocytoma is temozolomide (Temodal).
    • Other types of chemotherapy used to treat anaplastic astrocytoma are:
      • carmustine (BiCNU, BCNU)
      • lomustine (CeeNU, CCNU)
      • cisplatin (Platinol AQ)
      • procarbazine (Natulan)
      • vincristine (Oncovin)
    • The most common chemotherapy combination used to treat anaplastic astrocytoma is PCV – procarbazine (Natulan), lomustine (CCNU) and vincristine (Oncovin).
    • For more detailed information on specific drugs, go to sources of drug information.

 

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Glioblastoma multiforme

Glioblastoma multiforme (also called glioblastoma or GBM) are grade IV tumours. They are the most common malignant brain tumour in adults, accounting for approximately 50%–60% of all astrocytomas and approximately 12%–15% of all types of brain tumours. Most cases occur in people between the ages of 45 and 70 years.

  • The cells in these tumours are very abnormal in appearance.
  • Glioblastoma multiforme tumours tend to grow quickly and spread to nearby tissues.
  • They may develop in one place or in many places throughout the brain.

Treatment of glioblastoma multiforme

The following are treatment options for glioblastoma multiforme.

  • surgery
    • If surgery can be done, it is used as the first treatment to remove as much of the tumour as possible.
    • Surgery is followed by radiation therapy, with or without chemotherapy.
  • radiation therapy
    • External beam radiation therapy is used following surgery, with or without chemotherapy.
    • It may also be given as the main treatment if surgery is not an option.
  • chemotherapy
    • Chemotherapy may be given at the same time as radiation therapy following surgery.
    • It may also be used to treat recurrent glioblastoma multiforme.
    • During surgery, wafers containing concentrated does of carmustine (BiCNU, BCNU) may be placed in or near the area where the tumour was removed.
    • The most common single agent chemotherapy used to treat glioblastoma multiforme is temozolomide (Temodal).
    • Other types of chemotherapy used to treat glioblastoma multiforme are:
      • carmustine (BiCNU, BCNU)
      • lomustine (CeeNU, CCNU)
      • cisplatin (Platinol)
      • procarbazine (Natulan)
      • vincristine (Oncovin)
    • The most common chemotherapy combination used is PCV – procarbazine (Natulan), lomustine (CCNU) and vincristine (Oncovin).
    • For more detailed information on specific drugs, go to sources of drug information.
  • biological therapy
    • The biological therapy used to treat glioblastoma multiforme is bevacizumab (Avastin).

 

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Brain stem gliomas

Brain stem gliomas are astrocytomas that start in the brain stem. They can be low or high grade, ranging from grade I to III.These tumours are rare in adults. When they do occur in adults, it is most often between 30 and 40 years of age.

Treatment of brain stem gliomas

Treatment options for brain stem gliomas may include:

  • surgery
    • Surgery may be used if the tumour is localized (has not spread) and can be reached.
    • Most tumours invade different areas of the brain stem and cannot be surgically removed.
  • radiation therapy
    • Radiation therapy is given if the person has many symptoms.
    • If the person does not have any symptoms, radiation therapy may be postponed until the tumour grows or symptoms develop.
  • chemotherapy
    • Chemotherapy is given if the tumour progresses after radiation therapy.

 

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Supportive therapy

Supportive therapy is used to treat the symptoms caused by astrocytomas. The following types of supportive therapy may be used:

  • anticonvulsants
    • These drugs prevent seizures.
    • They are given to people who have had a previous seizure.
    • The most commonly used anticonvulsant used is phenytoin (Dilantin).
  • corticosteroids
    • These drugs are used to reduce cerebral edema (buildup of fluid in the brain).
    • The most commonly used corticosteroid is dexamethasone (Decadron, Dexasone).

 

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Clinical trials

People with astrocytoma may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.

 

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References

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We can give information about cancer care and support services in Canada only. To find a cancer organization in your country, visit Union for International Cancer Control or International Cancer Information Service Group.