How Pilocytic Astrocytoma Is Treated

Pilocytic astrocytoma (PA) is highly curable. In most cases, the complete removal of the tumor, called surgical resection, leads to a prompt resolution of symptoms without the need for chemotherapy or radiation. 

This article discusses the treatment options for PA.

Lifestyle Changes

No lifestyle risk factors have been singled out as a cause of PA. In fact, efforts such as reducing environmental exposures to ionizing radiation from cell phone use and occupational exposure to radiation and toxic chemicals have not proven to lower the incidence of PA. The association between these exposures and the development of PA is weak at best.

The following healthy lifestyle behaviors may reduce your overall cancer risk:

• Limiting exposure to toxic chemicals and radiation (especially in children)
• Eating a healthy diet, particularly one that is free of processed foods, saturated fats, and high levels of red meat
• Never smoking
• Routine exercise

Over-the-Counter (OTC) Therapies

Headache is one of the most common symptoms of juvenile and adult cases of PA.

In adult cases taking OTC pain-relieving medications like Advil or Motrin (ibuprofen) or Tylenol (acetaminophen) may be helpful.

Of note, headache is usually a sign of increased pressure in the brain. Treatment is the surgical removal of the PA tumor.

Prescriptions

The types of medication you will use for PA depend on the symptoms you are experiencing. For example, if you have a seizure, your provider may prescribe an anticonvulsant like Keppra (levetiracetam), Dilantin (phenytoin), or Tegretol (carbamazepine).

Levetiracetam is the most prescribed of the three because it does not interact with chemotherapy drugs (the use of chemicals to treat a disease). Steroid therapy may be combined with drugs called gastroprotectants, like proton pump inhibitors or antacids, to reduce vasogenic edema (a type of swelling that can breach the blood-brain barrier) around the tumor. Steroid therapy may help if you are experiencing symptoms of increased cranial (within the skull) pressure like headaches and changes in vision.

The use of immunotherapy, such as the monoclonal antibody Avastin (bevacizumab), is becoming more popular, especially in difficult-to-manage cases.

PAs are highly vascular tumors (consisting of many blood vessels). Avastin targets and blocks a protein found in cancerous cells called vascular endothelial growth factor that signals new blood vessel growth in tumors. Repeat treatments with Avastin have reduced tumor activity, particularly in adult pilocytic astrocytomas, which are generally more aggressive and harder to treat than those in children.

Whether you or your child is a good candidate for these treatments is based on genes, traits of the tumor, and the possibility of a cure using other treatment options.

Surgeries and Specialist-Driven Procedures

Standard treatment is surgical resection of the tumor. The goal of surgery is to remove as much of the tumor as possible. A neurosurgeon (a specialist who diagnoses and surgically treats conditions of the brain and spinal cord) or a neuro-oncologist (a specialist who diagnoses and treats brain and spinal cord tumors) usually performs this surgery. 

PAs are commonly grade 1 tumors—small, localized tumors that are rarely malignant in nature. This makes them highly curable with complete removal of the tumor. If a PA tumor is completely removed, the use of chemotherapy or radiation is usually not necessary. A short course of chemotherapy may be used to ensure that microscopic cancer cells are destroyed in higher-grade tumors.

Radiation is only used for high-grade tumors. The combination of surgery, targeted therapies, and chemotherapy usually results in a cure rate as high as 90%–95%.

Summary

PA is a highly curable condition with complete removal of the tumor. Promising new research shows that using immunotherapy, such as monoclonal antibodies, may improve the outlook for recurrent and hard-to-treat cases of PA in both children and adults.

A Word From Verywell

The earlier you start treatment, the more likely it is that you will achieve a cure for your or your child's PA. The research on PA is ever-growing and the rise of personalized medicine means that your healthcare providers are well equipped to provide a detailed plan that meets your treatment goals. Be sure to ask your provider about all available options before moving forward.