Astrocytoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
The mainstay of treatment for low grade astrocytoma is wait and see approach, radiation therapy and chemotherapy. Treatment for anaplastic astrocytoma is radiotherapy with adjunctive chemotherapy, radiotherapy alone and chemotherapy alone. Treatment for glioblastoma multiform is chemotherapy and radiotherapy, Bevacizumab, alternating electric fields and Carmustine polymer wafers.
Medical Therapy
- Post surgical medical therapy is recommended in all patients with astrocytoma tumor.
Astrocytoma
- 1 Grade 1 and 2 - Low grade astrocytomas
- 1.1 Wait and see[1][2]
- The wait and see approach is for young patient with complete or nearly complete tumor resection.
- since the low grade astrocytoma will finally grow to high grade astrocytoma, we should screen these patients with contrast MRI every 4 month.
- 1.2 Radiation therapy[3][4]
- Immediate post surgery radiation therapy can reduce the progression rate.
- It doesn't affect survival since it cannot prevent transformation of low grade astrocytoma to high grade astrocytoma.
- Preferred regimen: 50 t0 54 Gy
- 1.3 Adjunctive chemotherapy[5][6][7]
- 1.3.1 Temozolomide
- 1.3.2 PVC (Procarbazine, Lomustine, Vincristine)
- Based on previous studies, patients who get chemotherapy along with radiotherapy immediately after surgery has better outcome.
- 1.1 Wait and see[1][2]
- 2 Grade 3 - Anaplastic astrocytoma
- 2.1 Radiotherapy+ chemotherapy (Temozolomide)[8][9]
- Studies demonstrated that the combination of radiotherapy and chemotherapy with temozolomide is more effective.
- 2.2 Radiation
- 2.3 Chemotherapy
- 2.3.1 Procarbazine, Lomustine, Vincristine
- 2.3.2 Procarbazine, Lomustine, Temozolomide[10][11]
- 2.1 Radiotherapy+ chemotherapy (Temozolomide)[8][9]
- 3 Grade 4 - Glioblastoma multiform
- 3.1 Chemotherapy (± radiotherapy)[12][13]
- 3.1.1 Temozolomide
- 3.2 Bevacizumab[14]
- A monoclonal antibody which bind to VEGF and inactivate it.
- 3.3 Alternating electric fields[15]
- A portable device which will be placed on the scalp for generating TT fields. The combination of this device with Temozolomide will significantly increase survival.
- 3.4 Carmustine polymer wafers[16]
- Implanted at the time of surgery.
- Can be used in combination with chemotherapy or radiation.
- 3.1 Chemotherapy (± radiotherapy)[12][13]
References
- ↑ Ricard D, Kaloshi G, Amiel-Benouaich A, Lejeune J, Marie Y, Mandonnet E, Kujas M, Mokhtari K, Taillibert S, Laigle-Donadey F, Carpentier AF, Omuro A, Capelle L, Duffau H, Cornu P, Guillevin R, Sanson M, Hoang-Xuan K, Delattre JY (May 2007). "Dynamic history of low-grade gliomas before and after temozolomide treatment". Ann. Neurol. 61 (5): 484–90. doi:10.1002/ana.21125. PMID 17469128.
- ↑ Shaw EG, Berkey B, Coons SW, Bullard D, Brachman D, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta M (November 2008). "Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial". J. Neurosurg. 109 (5): 835–41. doi:10.3171/JNS/2008/109/11/0835. PMC 3833272. PMID 18976072.
- ↑ van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmström PO, Collette L, Piérart M, Mirimanoff R, Karim AB (2005). "Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial". Lancet. 366 (9490): 985–90. doi:10.1016/S0140-6736(05)67070-5. PMID 16168780.
- ↑ Ryken TC, Parney I, Buatti J, Kalkanis SN, Olson JJ (December 2015). "The role of radiotherapy in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline". J. Neurooncol. 125 (3): 551–83. doi:10.1007/s11060-015-1948-1. PMID 26530266.
- ↑ van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, Brandes AA, Clement PM, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Brachman DG, Taal W, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Weber DC, Lesimple T, Clenton S, Gijtenbeek A, Pascoe S, Herrlinger U, Hau P, Dhermain F, van Heuvel I, Stupp R, Aldape K, Jenkins RB, Dubbink HJ, Dinjens W, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, Wick W, Kros JM (October 2017). "Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study". Lancet. 390 (10103): 1645–1653. doi:10.1016/S0140-6736(17)31442-3. PMC 5806535. PMID 28801186. Vancouver style error: initials (help)
- ↑ Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ (April 2016). "Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma". N. Engl. J. Med. 374 (14): 1344–55. doi:10.1056/NEJMoa1500925. PMC 5170873. PMID 27050206.
- ↑ Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP (September 2012). "Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802". J. Clin. Oncol. 30 (25): 3065–70. doi:10.1200/JCO.2011.35.8598. PMC 3732006. PMID 22851558.
- ↑ Juratli TA, Lautenschläger T, Geiger KD, Pinzer T, Krause M, Schackert G, Krex D (September 2015). "Radio-chemotherapy improves survival in IDH-mutant, 1p/19q non-codeleted secondary high-grade astrocytoma patients". J. Neurooncol. 124 (2): 197–205. doi:10.1007/s11060-015-1822-1. PMID 26033545.
- ↑ Shin JY, Diaz AZ (September 2016). "Anaplastic astrocytoma: prognostic factors and survival in 4807 patients with emphasis on receipt and impact of adjuvant therapy". J. Neurooncol. 129 (3): 557–565. doi:10.1007/s11060-016-2210-1. PMID 27401155.
- ↑ Wick W, Hartmann C, Engel C, Stoffels M, Felsberg J, Stockhammer F, Sabel MC, Koeppen S, Ketter R, Meyermann R, Rapp M, Meisner C, Kortmann RD, Pietsch T, Wiestler OD, Ernemann U, Bamberg M, Reifenberger G, von Deimling A, Weller M (December 2009). "NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide". J. Clin. Oncol. 27 (35): 5874–80. doi:10.1200/JCO.2009.23.6497. PMID 19901110.
- ↑ Wick W, Roth P, Hartmann C, Hau P, Nakamura M, Stockhammer F, Sabel MC, Wick A, Koeppen S, Ketter R, Vajkoczy P, Eyupoglu I, Kalff R, Pietsch T, Happold C, Galldiks N, Schmidt-Graf F, Bamberg M, Reifenberger G, Platten M, von Deimling A, Meisner C, Wiestler B, Weller M (November 2016). "Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide". Neuro-oncology. 18 (11): 1529–1537. doi:10.1093/neuonc/now133. PMC 5063521. PMID 27370396.
- ↑ Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (March 2005). "Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma". N. Engl. J. Med. 352 (10): 987–96. doi:10.1056/NEJMoa043330. PMID 15758009.
- ↑ Kole AJ, Park HS, Yeboa DN, Rutter CE, Corso CD, Aneja S, Lester-Coll NH, Mancini BR, Knisely JP, Yu JB (August 2016). "Concurrent chemoradiotherapy versus radiotherapy alone for "biopsy-only" glioblastoma multiforme". Cancer. 122 (15): 2364–70. doi:10.1002/cncr.30063. PMID 27172136.
- ↑ Lai A, Tran A, Nghiemphu PL, Pope WB, Solis OE, Selch M, Filka E, Yong WH, Mischel PS, Liau LM, Phuphanich S, Black K, Peak S, Green RM, Spier CE, Kolevska T, Polikoff J, Fehrenbacher L, Elashoff R, Cloughesy T (January 2011). "Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme". J. Clin. Oncol. 29 (2): 142–8. doi:10.1200/JCO.2010.30.2729. PMC 3058273. PMID 21135282.
- ↑ Stupp R, Wong ET, Kanner AA, Steinberg D, Engelhard H, Heidecke V, Kirson ED, Taillibert S, Liebermann F, Dbalý V, Ram Z, Villano JL, Rainov N, Weinberg U, Schiff D, Kunschner L, Raizer J, Honnorat J, Sloan A, Malkin M, Landolfi JC, Payer F, Mehdorn M, Weil RJ, Pannullo SC, Westphal M, Smrcka M, Chin L, Kostron H, Hofer S, Bruce J, Cosgrove R, Paleologous N, Palti Y, Gutin PH (September 2012). "NovoTTF-100A versus physician's choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality". Eur. J. Cancer. 48 (14): 2192–202. doi:10.1016/j.ejca.2012.04.011. PMID 22608262.
- ↑ Westphal M, Hilt DC, Bortey E, Delavault P, Olivares R, Warnke PC, Whittle IR, Jääskeläinen J, Ram Z (April 2003). "A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma". Neuro-oncology. 5 (2): 79–88. doi:10.1093/neuonc/5.2.79. PMC 1920672. PMID 12672279.