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
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 Radiotherpay+ chemotherapy
- Procarbazine, lomustine, vincristine
- Procarbazine, lomustine, temozolomide
- 2.1 Radiotherpay+ chemotherapy
- 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
- 3.1 Chemotherapy
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.