|
|
| Line 5: |
Line 5: |
| The optimal [[therapy]] for astrocytoma depends on the stage at [[diagnosis]]. [[Chemotherapy]] is recommended for children. [[Radiation]] and [[chemotherapy]] with [[stem cell transplant]] is recommended for adults with high grade astrocytoma. | | The optimal [[therapy]] for astrocytoma depends on the stage at [[diagnosis]]. [[Chemotherapy]] is recommended for children. [[Radiation]] and [[chemotherapy]] with [[stem cell transplant]] is recommended for adults with high grade astrocytoma. |
| ==Medical Therapy== | | ==Medical Therapy== |
| * Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. | | * Post surgical medical therapy is recommended in all patients with astrocytoma tumor. |
| * Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
| |
| * Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
| |
| * Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
| |
|
| |
|
| === Astrocytoma === | | === Astrocytoma === |
| Line 29: |
Line 26: |
| ** 3.3 Alternating electric fields | | ** 3.3 Alternating electric fields |
| ** 3.4 Carmustine polymer wafers | | ** 3.4 Carmustine polymer wafers |
|
| |
| ===Chemotherapy===
| |
| * [[Chemotherapy]] is a [[cancer]] treatment that uses [[drug]]s to stop the growth of [[cancer]] [[cell]]s, either by killing the [[cell]]s or by stopping them from dividing. When [[chemotherapy]] is taken by [[mouth]] or injected into a [[vein]] or [[muscle]], the [[drug]]s enter the [[bloodstream]] and can reach [[cancer]] [[cell]]s throughout the [[body]] (systemic [[chemotherapy]]). When [[chemotherapy]] is placed directly into the [[cerebrospinal fluid]], an [[organ]], or a [[body]] cavity such as the [[abdomen]], the [[drug]]s mainly affect [[cancer]] [[cell]]s in those areas (regional [[chemotherapy]]). Combination chemotherapy is the use of more than one anticancer drug.
| |
| *Systemic [[chemotherapy]] is used in the treatment of children with astrocytoma. The way the [[chemotherapy]] is given depends on the type of [[tumor]] and where the [[tumor]] formed in the [[brain]] or [[spinal cord]].
| |
|
| |
| ====High-dose Chemotherapy with Stem Cell Transplant====
| |
| * High-dose [[chemotherapy]] with [[stem cell]] [[transplant]] is a way of giving high doses of [[chemotherapy]] and replacing [[blood]] -forming [[cell]]s destroyed by the [[cancer]] treatment. [[Stem cell]]s (immature [[blood cell]]s) are removed from the [[blood]] or [[bone marrow]] of the [[patient]] or a [[donor]] and are frozen and stored. After the [[chemotherapy]] is completed, the stored [[stem cell]]s are thawed and given back to the patient through an infusion. These reinfused [[stem cell]]s grow into (and restore) the body's [[blood cell]]s.
| |
| * Treatment depends on the size and type of [[tumor]] and the child's general health. The goals of treatment may be to cure the [[tumor]], relieve symptoms, and improve [[brain]] function or the child's comfort
| |
| * Two related drugs have been shown to shrink or stabilize supependymal giant cell tumors: [[rapamycin]] and [[everolimus]]. These both belong to the [[mTOR]] inhibitor class of [[immunosuppressant]]s, and are both contraindicated in patients with severe [[infection]]s.
| |
| :* [[Rapamycin]] showed efficacy in five cases of SEGA in TSC patients, shrinking their [[tumor]] volumes by an average of 65%. However, after the [[drug]] was stopped, the [[tumor]]s regrew.
| |
| :* [[Everolimus]] which has a similar structure as [[rapamycin]], but with slightly increased bioavailability and shorter half-life, was studied in 28 patients with SEGA. There was a significant reduction in SEGA size in 75% of the patients, and a mild improvement in their seizures. [[Everolimus]] was approved for the treatment of SEGA by the US Food and Drug Administration (FDA) in October, 2010.
| |
| * Medicines used to treat primary [[brain tumor]]s in children include:
| |
| :* [[Corticosteroid]]s to reduce [[brain]] [[swelling]]
| |
| :* [[Diuretics]] (water pills) to reduce [[brain]] [[swelling]] and pressure
| |
| :* [[Anticonvulsant]]s to reduce or prevent [[seizure]]s
| |
| :* [[Pain]] medicines
| |
| * Comfort measures, safety measures, [[physical therapy]], occupational [[therapy]], and other such steps may be required to improve quality of life.
| |
| * Despite decades of therapeutic research, curative intervention is still nonexistent for high grade astrocytomas; patient care ultimately focuses on [[palliative]] management.
| |
|
| |
| ===Radiation Therapy===
| |
| * [[Radiation therapy]] is a [[cancer]] treatment that uses high-energy x-rays or other types of [[radiation]] to kill [[cancer cell]]s or keep them from growing. There are two types of [[radiation therapy]]:
| |
| ** External [[radiation therapy]] uses a machine outside the body to send [[radiation]] toward the [[cancer]].
| |
| ** Internal [[radiation therapy]] uses a radioactive substance sealed in [[needle]]s, seeds, wires, or [[catheter]]s that are placed directly into or near the [[cancer]].
| |
| * External [[radiation therapy]] is used to treat astrocytoma in children. The way the [[radiation therapy]] is given depends on the type of [[tumor]] and where the [[tumor]] formed in the [[brain]] or [[spinal cord]].[[Radiation therapy]] to the [[brain]] can affect growth and development in young children. Certain ways of giving [[radiation therapy]] can lessen the damage to healthy [[brain]] tissue:
| |
| ** Conformal [[radiation therapy]] uses a computer to make a 3-dimensional (3-D) picture of the [[tumor]] and shapes the [[radiation]] beams to fit the [[tumor]]. This allows a high dose of [[radiation]] to reach the [[tumor]] and causes less damage to normal [[tissue]] around the [[tumor]].
| |
| ** Intensity-modulated [[radiation therapy]] (IMRT) uses images created by a computer that show the size and shape of the [[tumor]]. Thin beams of [[radiation]] of different strengths are aimed at the [[tumor]] from many angles.
| |
| ** Stereotactic [[radiation therapy]] uses a rigid head frame attached to the [[skull]] to aim [[radiation]] directly to the [[tumor]], causing less damage to normal [[tissue]] around the [[tumor]]. The total dose of [[radiation]] is divided into several smaller doses given over several days. This procedure is also called stereotactic external-beam [[radiation therapy]] and stereotaxic [[radiation therapy]].
| |
| ** Proton beam [[radiation therapy]] is a type of high-energy, external [[radiation therapy]] that uses streams of [[proton]]s (small, positively-charged particles of matter) to kill [[tumor]] cells.
| |
| * For children younger than 3 years, [[chemotherapy]] may be given instead, to delay or reduce the need for [[radiation therapy]].<ref name="NCI">{{cite web | title = National Caner Institute Astrocytoma| url =http://www.cancer.gov/types/brain/hp/child-astrocytoma-treament-pdq#cit/section_1.19 }}</ref>
| |
| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |