How Anaplastic Astrocytoma Is Treated

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Surgery is often the first-line treatment for anaplastic astrocytoma, a rare malignant brain tumor. Surgery typically is followed by a combination of radiation and chemotherapy treatments, with chemotherapy continuing once radiation treatments end.

The specific treatment plan will be based on a number of factors, including where the tumor is and whether it has spread to other areas, as well as the patient's age and general health. This article will discuss the most common treatment procedures as well as new therapies that are under investigation as potential treatments.

Doctor and patient looking at MRI image

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Surgeries

In most cases, the first-line treatment for anaplastic astrocytoma is surgery to remove the tumor or as much of it as possible. Since anaplastic astrocytomas can occur in or near areas of the brain that control bodily functions such as movement, sensation, language, and vision, special measures must be taken in surgery to monitor and protect these functions.

This may involve the patient being awake during part of the surgery. For example, if the tumor is near the area of the brain that controls language, the patient may be asked to answer questions and undergo various speech tests.

It may seem very scary to be awake while undergoing surgery, but you would only be awake for a short time in the middle. Also, there are no pain receptors in the brain, so you won't feel anything, and you will be monitored throughout to make sure you aren't feeling any pain.

There are several types of brain surgery. Which type you will need depends on the size and location of your tumor. 

Craniotomy

Craniotomy is traditional open-brain surgery. It involves the removal of a piece of the skull called a bone flap so that the neurosurgeon can access the brain.

After surgery, the flap will normally be placed back where it was so that it can mend. In some cases, the bone flap will be held in place with small metal plates, much like a cast for a broken arm.

After several months, the bone will be nearly as strong as it was prior to surgery.

Neuroendoscopy

Neuroendoscopy is a minimally invasive procedure in which the neurosurgeon makes a small hole in the skull about the size of a dime to remove the tumor. In some cases, the surgeon may be able to remove the tumor through the mouth or nose.

A neuroendoscopy is performed using a small telescope-like instrument called an endoscope. It has a high-resolution video camera atached, which allows the neurosurgeon to navigate and access the tumor.

This type of procedure can be used to remove smaller tumors or tumors that are in deep regions of the brain. It may also be used to perform a biopsy, a procedure in which a small tissue sample is removed for examination in a lab.

Laser Ablation

Laser ablation is a type of minimally invasive neurosurgical technique that involves using lasers, guided by a type of brain imaging scan (magnetic resonance imaging, MRI), to target the tumor. Compared to open-brain surgery, it has a shorter recovery time and involves less pain.

Risks

There are several risks of brain surgery that apply to all types of surgery and include:

  • Swelling in the brain: This is called cerebral edema. It involves the accumulation of fluid in brain tissue. It can cause problems such as numbness, weakness, or difficulty with speech or movement. If the fluid buildup or swelling is persistent, a ventriculoperitoneal shunt, which relieves pressure on the brain from the buildup, may be placed. 
  • Blood clots: Clots may form more readily after brain surgery, so preventive treatments may be needed.
  • Injury to other areas of the brain: For instance, if the tumor is at the skull base, cranial nerves in that area may be at risk during the surgery. 

Surgery Is Not Always Possible

Sometimes surgery is not possible if the tumor is in an area where vital functions may be damaged, such as if the tumor is near a major blood vessel or in the brain stem.

Specialist-Driven Procedures

Anaplastic astrocytomas tend to spread into neighboring healthy tissue. This means that it can be difficult to fully remove all cancer cells. In that case, as well as when there may be possible cells remaining after surgery, radiotherapy may be recommended.

Radiotherapy

Radiotheraphy, or radiation therapy, is frequently used to treat anaplastic astrocytomas after surgery. However, treatment may involve radiation alone if surgery is not possible.

Radiation therapy is used to kill rapidly dividing cells, primarily cancerous cells. However, some healthy cells, such as hair follicles, may also be damaged, leading to certain side effects. As such, the dosage of radiation needed will be carefully calculated to try to minimize damage to normal cells.

As anaplastic astrocytomas are located in the brain, treating this type of cancer is a delicate operation. As such, radiation procedures may be chosen that can give greater precision. These include:

  • Gamma Knife radiosurgery: Although referred to as surgery, this doesn't involve actual incisions. Instead, a highly focused beam of radiation is used to precisely destroy areas of tissue.
  • Intensity-modulated radiation therapy (IMRT): This type of advanced radiation therapy uses multiple small beams of varying strengths of radiation to precisely treat the tumor. This technique can also limit side effects as it decreases unnecessary radiation exposure.

Recap

In most cases, surgery is the first-line treatment for anaplastic astrocytoma. However, since this type of tumor often cannot be completely removed through surgery, radiation therapy also is a part of a patient's treatment plan.

Medications

Medications used for anaplastic astrocytoma may include chemotherapy and pain medications. Chemotherapy is a type of treatment that uses drugs called chemotherapeutic agents to shrink or eliminate brain tumors.

Other prescription medications, such as steroids, may be used to control symptoms while the tumor is being treated.

Chemotherapy

Most chemotherapeutic agents have demonstrated only limited effectiveness in treating anaplastic astrocytoma.

Only one chemotherapeutic agent, Temodar (temozolomide), has been approved by the Food and Drug Administration (FDA) for adults with treatment-resistant anaplastic astrocytoma. No agents are approved for use in children.

Anaplastic astrocytoma is typically treated first with surgery and then with a combination of chemotherapy (usually Temodar) and radiation. After a four-week period of recovery, this is followed by cycles of Temodar.

Temodar typically is given daily for five days at a time every 28 days. A patient will undergo six to 12 cycles. This drug increases the risk of hematologic complications, such as thrombocytopenia (low platelet count, which can lead to bleeding issues), so blood tests must be checked 21 and 28 days into each cycle of treatment. Other side effects may include nausea, fatigue, and a decreased appetite. 

New Therapies

A variety of new therapies are under investigation as potential treatments for anaplastic astrocytoma, especially recurrent tumors, which are harder to treat.

Large-scale genomic studies have identified several common genetic mutations in tumors such as anaplastic astrocytomas. Some of these genes are involved in the production of enzymes, which regulate the rate at which chemical reactions in the body occur. Drugs that inhibit, or stop, the production of the enzymes of these genes are currently being tested.

Another treatment currently being investigated is autophagy. Autophagy is a biological process that breaks down unnecessary or damaged components of a cell and recycles them as the building blocks of new cells or to repair other cells. Using drugs to ramp up this process has significantly improved the efficiency of tumor removal.

Using this process to cause cell death has emerged as a promising strategy to remove tumor cells. However, more investigation is needed into the extent autophagy can be controlled in the treatment of anaplastic astrocytomas.

Convection-enhanced delivery (CED) is a new, experimental technique that delivers high levels of chemotherapy directly into the tumor and surrounding brain tissue. However, randomized trials have not been able to definitively show that it is more effective than traditional chemotherapy.

Immunotherapy, which stimulates the immune system to attack the tumor cells, is another type of therapy being explored for high-grade gliomas. The types of immunotherapy that have been tried are vaccines, checkpoint inhibitors, and adoptive T cell therapy. So far, there has not been success in clinical trials.

Over-the-Counter (OTC) Therapies

Although they can't treat the condition, over-the-counter medications can help relieve some of the symptoms of a brain tumor. 

There are several OTC medications that you can take to relieve pain from headaches. These include:

  • Tylenol (acetaminophen)
  • Advil (ibuprofen)
  • Aleve (naproxen sodium)
  • Excedrin (acetaminophen, aspirin, and caffeine)

Though you may have used these medications prior to being diagnosed with a brain tumor, know that some of them can increase the risk of bleeding after surgery.

Make sure you speak to your doctor about the safety of any OTC medications you are using or plan to use.

Summary

Surgery is often the initial treatment for anaplastic astrocytoma, usually followed by radiation therapy and chemotherapy used in combination. Chemotherapy will continue once radiation treatments have ended. Chemo is especially helpful in cases of recurrent tumors, which are harder to treat.

A Word From Verywell

It can be difficult to make decisions about which course of action to take. Your doctor and other members of your health team will help you decide what the best therapies are for you.

Your doctor should also go through with you all the potential risks and benefits of each therapy before your treatment plan is decided on. Remember to ask lots of questions and bring up anything that you are concerned about.

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