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.

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
    • 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
    • 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
    • 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.

• 2 Grade 3 - Anaplastic astrocytoma
  • 2.1 Radiotherpay+ chemotherapy
    • Procarbazine, lomustine, vincristine
    • Procarbazine, lomustine, temozolomide

• 3 Grade 4 - Glioblastoma multiform
  • 3.1 Chemotherapy
    • 3.1.1 Temozolomide
  • 3.2 Bevacizumab
  • 3.3 Alternating electric fields
  • 3.4 Carmustine polymer wafers