Anaplastic Astrocytoma

Abstract

Standard treatment of anaplastic astrocytoma (AA) in good performance patients consists of maximal safe surgical resection followed by focal, fractionated, external beam radiotherapy (RT) alone or in combination with concurrent and adjuvant temozolomide (TMZ). Since prospective data regarding the use of chemoradiotherapy for AA is lacking, the practice is based on the extrapolation of results from a randomized study in glioblastoma (GB). Whether the data from the GB study can and should be extrapolated is controversial, although a large multicenter, randomized, phase III study is underway to define optimal initial AA treatment. Patients should be tapered off corticosteroids completely or to the lowest dose necessary to treat neurologic dysfunction. Anti-epileptic drugs (AED) are not indicated unless there is a history of seizure; levetiracetam is the preferred AED in malignant glioma (MG). Unless there is evidence of intracranial hemorrhage, venous thromboembolism (VTE) should be treated with low-molecular-weight heparin (LMWH) therapy. At recurrence, patients with good performance status are usually treated with cytotoxic chemotherapy following, or in lieu of, repeat surgery. TMZ is the preferred chemotherapeutic agent in patients without prior exposure; lomustine is recommended for tumors resistant to TMZ. In patients with neurologic dysfunction secondary to tumor edema and mass effect who are not amenable to surgery, the use of bevacizumab is associated with improved neurologic function and better quality of life. Given the limited treatment options at tumor recurrence, consideration for enrollment on a clinical trial is encouraged.

Limited advances in therapy of glioblastoma trigger re-consideration of research policy

“…These early observed occurrences of GB develop rapidly with the tumour size in some cases multiplying by 32 in one month [1]. Standard treatment of GB in good performance patients consists of maximal safe surgical resection to achieve tumour debulking followed by focal, fractionated, external beam radiotherapy (RT) alone or in combination with concurrent and adjuvant temozolomide (TMZ) [2]. Patients are usually tapered off corticosteroids to the lowest dose necessary to treat neurologic dysfunction.…”

Improving control of high‐grade glioma by ultra‐hyper‐fractionated radiotherapy

“…They have an annual incidence of 4 to 6 people per 100,000 (Global Burden of Disease Cancer Collaboration et al, 2019; Omuro & DeAngelis, 2013). Temozolomide (TMZ) is the preferred chemotherapeutic agent in patients without prior exposure (Ghia, 2018; Grimm & Pfiffner, 2013). The therapy may also include corticosteroids to treat neurologic dysfunction, anti‐epileptic drugs such as levetiracetam for the treatment of seizures, and low‐molecular‐weight heparin for that of venous thromboembolism.…”

Intraoperative MRI for neurosurgical and general surgical interventions

“…It is now being used worldwide for a variety of neurosurgical procedures to enhance patient safety during resection of tumors of the brain, both in pediatric and in adult patients [2][3][4][5][6]. Its use has exploded and expanded beyond tumor resection to assist the surgeon in a variety of cases such as diagnosis and surgical revascularization of moyamoya arteriopathy and arteriovenous malformations, placement of deep brain stimulator for Parkinson's disease and focal and generalized dystonia, removal of hematomas, and surgical resection for the treatment of epilepsy, both asleep and awake [7][8][9][10][11][12][13][14][15]. IMRI may also provide assistance in identifying intraoperative complications such as bleeding and/or hematoma formation outside the visual operating field.…”