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{{Astrocytoma}}
{{Astrocytoma}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{Fs}}
==Overview==
==Overview==
The optimal [[therapy]] of astrocytoma depends on the stage of [[diagnosis]]. [[Chemotherapy]] is recommended for children. [[Radiation]] and [[chemotherpy]] with [[stem cell transplant]] is recommended for adults with high grade astrocytoma.
The mainstay of treatment for [[low grade astrocytoma]] is wait and see approach, [[Radiation therapy|radiation]] therapy and [[chemotherapy]]. Treatment for [[anaplastic astrocytoma]] is [[radiotherapy]] with adjunctive [[chemotherapy]], [[Radiation therapy|radiotherapy]] alone and [[chemotherapy]] alone. Treatment for [[Glioblastoma multiforme|glioblastoma multiform]] is [[chemotherapy]] and [[Radiation therapy|radiotherapy]], [[Bevacizumab]], alternating electric fields and [[Carmustine]] polymer wafers.
 
==Medical Therapy==
==Medical Therapy==
* Post surgical medical therapy is recommended in all patients with astrocytoma tumor.


===Chemotherapy===
=== Astrocytoma ===
* [[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.
* '''1 Grade 1 and 2 - Low grade astrocytomas'''
*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]].
** 1.1 Wait and see<ref name="pmid17469128">{{cite journal |vauthors=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 |title=Dynamic history of low-grade gliomas before and after temozolomide treatment |journal=Ann. Neurol. |volume=61 |issue=5 |pages=484–90 |date=May 2007 |pmid=17469128 |doi=10.1002/ana.21125 |url=}}</ref><ref name="pmid18976072">{{cite journal |vauthors=Shaw EG, Berkey B, Coons SW, Bullard D, Brachman D, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta M |title=Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial |journal=J. Neurosurg. |volume=109 |issue=5 |pages=835–41 |date=November 2008 |pmid=18976072 |pmc=3833272 |doi=10.3171/JNS/2008/109/11/0835 |url=}}</ref>
 
*** The wait and see approach is for young patient with complete or nearly complete [[tumor]] resection.  
====High-dose chemotherapy with stem cell transplant====
*** since the [[low grade astrocytoma]] will finally grow to [[high grade astrocytoma]], we should screen these patients with contrast [[MRI]] every 4 month.
* 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.
** 1.2 [[Radiation therapy]]<ref name="pmid16168780">{{cite journal |vauthors=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 |title=Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial |journal=Lancet |volume=366 |issue=9490 |pages=985–90 |date=2005 |pmid=16168780 |doi=10.1016/S0140-6736(05)67070-5 |url=}}</ref><ref name="pmid26530266">{{cite journal |vauthors=Ryken TC, Parney I, Buatti J, Kalkanis SN, Olson JJ |title=The role of radiotherapy in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline |journal=J. Neurooncol. |volume=125 |issue=3 |pages=551–83 |date=December 2015 |pmid=26530266 |doi=10.1007/s11060-015-1948-1 |url=}}</ref>
* 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
*** Immediate post [[surgery]] [[radiation therapy]] can reduce the progression rate.
* 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.
*** It doesn't affect survival since it cannot prevent transformation of [[low grade astrocytoma]] to [[high grade astrocytoma]].  
:* [[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.
*** Preferred regimen: 50 t0 54 Gy
:* [[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.
** 1.3 Adjunctive [[chemotherapy]]<ref name="pmid28801186">{{cite journal |vauthors=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 WNM, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, Wick W, Kros JM |title=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 |journal=Lancet |volume=390 |issue=10103 |pages=1645–1653 |date=October 2017 |pmid=28801186 |pmc=5806535 |doi=10.1016/S0140-6736(17)31442-3 |url=}}</ref><ref name="pmid27050206">{{cite journal |vauthors=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 |title=Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma |journal=N. Engl. J. Med. |volume=374 |issue=14 |pages=1344–55 |date=April 2016 |pmid=27050206 |pmc=5170873 |doi=10.1056/NEJMoa1500925 |url=}}</ref><ref name="pmid22851558">{{cite journal |vauthors=Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP |title=Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802 |journal=J. Clin. Oncol. |volume=30 |issue=25 |pages=3065–70 |date=September 2012 |pmid=22851558 |pmc=3732006 |doi=10.1200/JCO.2011.35.8598 |url=}}</ref>
* Medicines used to treat primary [[brain tumor]]s in children include:
*** 1.3.1 [[Temozolomide]]
:* [[Corticosteroid]]s to reduce [[brain]] [[swelling]]
*** 1.3.2 PVC ([[Procarbazine]], [[Lomustine]], [[Vincristine]])
:* [[Diuretics]] (water pills) to reduce [[brain]] [[swelling]] and pressure
*** Based on previous studies, patients who get [[chemotherapy]] along with [[Radiation therapy|radiotherapy]] immediately after [[surgery]] has better outcome.
:* [[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>
==Treatment Options for Childhood Astrocytomas==
===Newly Diagnosed Childhood Low-Grade Astrocytomas===
 
*When the tumor is first diagnosed, treatment for childhood low-grade astrocytoma depends where the tumor is, and is usually surgery. An MRI is done after surgery to see if there is tumor remaining.If the tumor was completely removed by surgery, more treatment may not be needed and the child is closely watched to see if signs or symptoms appear or change. This is called observation.
 
*If there is tumor remaining after surgery, treatment may include the following:
 
**Observation.
**A second surgery to remove the tumor.
**Radiation therapy, which may include conformal radiation therapy, intensity-modulated radiation therapy, or stereotactic radiation therapy, when the tumor begins to grow again.
**Combination chemotherapy with or without radiation therapy.
**A clinical trial of targeted therapy with selumetinib.
 
*In some cases, observation is used for children who have a visual pathway glioma. In other cases, treatment may include surgery to remove the tumor, radiation therapy, or chemotherapy. A goal of treatment is to save as much vision as possible. The effect of tumor growth on the child's vision will be closely followed during treatment.
 
*Children with neurofibromatosis type 1 (NF1) may not need treatment unless the tumor grows or signs or symptoms, such as vision problems, appear. When the tumor grows or signs or symptoms appear, treatment may include surgery to remove the tumor, radiation therapy, and/or chemotherapy.
 
*Children with tuberous sclerosis may develop benign (not cancer) tumors in the brain called subependymal giant cell astrocytomas (SEGAs). Targeted therapy with everolimus or sirolimus may be used instead of surgery, to shrink the tumors.
 
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood low-grade untreated astrocytoma or other tumor of glial origin. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
 
===Recurrent Childhood Low-Grade Astrocytomas.===
 
*Before more cancer treatment is given, imaging tests, biopsy, or surgery are done to find out if there is cancer and how much there is.
 
*Treatment of recurrent childhood low-grade astrocytoma may include the following:
 
**A second surgery to remove the tumor, if surgery was the only treatment given when the tumor was first diagnosed.
**Radiation therapy to the tumor only, if radiation therapy was not used when the tumor was first diagnosed. Conformal radiation therapy may be given.
**Chemotherapy, if the tumor recurred where it cannot be removed by surgery or the patient had radiation therapy when the tumor was first diagnosed.
**Chemotherapy and targeted therapy with bevacizumab.
 
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood astrocytoma or other tumor of glial origin. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
 
Newly Diagnosed Childhood High-Grade Astrocytomas
 
Treatment of childhood high-grade astrocytoma may include the following:
 
Surgery to remove the tumor, followed by chemotherapy and radiation therapy.
A clinical trial of chemotherapy with or without radiation therapy.
A clinical trial of a new treatment.
 
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood high-grade untreated astrocytoma or other tumor of glial origin. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
 
Recurrent Childhood High-Grade Astrocytomas
 
Before more cancer treatment is given, imaging tests, biopsy, or surgery are done find out if there is cancer and how much there is.


Treatment of recurrent childhood high-grade astrocytoma may include the following:


Surgery.
* '''2 Grade 3 - [[Anaplastic astrocytoma]]'''
High-dose chemotherapy with stem cell transplant.
** 2.1 [[Radiation therapy|Radiotherapy]]+ [[chemotherapy]] ([[Temozolomide]])<ref name="pmid26033545">{{cite journal |vauthors=Juratli TA, Lautenschläger T, Geiger KD, Pinzer T, Krause M, Schackert G, Krex D |title=Radio-chemotherapy improves survival in IDH-mutant, 1p/19q non-codeleted secondary high-grade astrocytoma patients |journal=J. Neurooncol. |volume=124 |issue=2 |pages=197–205 |date=September 2015 |pmid=26033545 |doi=10.1007/s11060-015-1822-1 |url=}}</ref><ref name="pmid27401155">{{cite journal |vauthors=Shin JY, Diaz AZ |title=Anaplastic astrocytoma: prognostic factors and survival in 4807 patients with emphasis on receipt and impact of adjuvant therapy |journal=J. Neurooncol. |volume=129 |issue=3 |pages=557–565 |date=September 2016 |pmid=27401155 |doi=10.1007/s11060-016-2210-1 |url=}}</ref>
A clinical trial of a new treatment.
*** Studies demonstrated that the combination of [[radiotherapy]] and [[chemotherapy]] with [[temozolomide]] is more effective.
A clinical trial of targeted therapy with dabrafenib.
** 2.2 [[Radiation therapy|Radiation]]
** 2.3 [[Chemotherapy]]
*** 2.3.1 [[Procarbazine]], [[Lomustine]], [[Vincristine]]
*** 2.3.2 [[Procarbazine]], [[Lomustine]], [[Temozolomide]]<ref name="pmid19901110">{{cite journal |vauthors=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 |title=NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide |journal=J. Clin. Oncol. |volume=27 |issue=35 |pages=5874–80 |date=December 2009 |pmid=19901110 |doi=10.1200/JCO.2009.23.6497 |url=}}</ref><ref name="pmid27370396">{{cite journal |vauthors=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 |title=Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide |journal=Neuro-oncology |volume=18 |issue=11 |pages=1529–1537 |date=November 2016 |pmid=27370396 |pmc=5063521 |doi=10.1093/neuonc/now133 |url=}}</ref>


Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood astrocytoma or other tumor of glial origin. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.


* '''3 Grade 4 - [[Glioblastoma multiforme|Glioblastoma multiform]]'''
** 3.1 [[Chemotherapy]] (± [[Radiation therapy|radiotherapy]])<ref name="pmid15758009">{{cite journal |vauthors=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 |title=Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma |journal=N. Engl. J. Med. |volume=352 |issue=10 |pages=987–96 |date=March 2005 |pmid=15758009 |doi=10.1056/NEJMoa043330 |url=}}</ref><ref name="pmid27172136">{{cite journal |vauthors=Kole AJ, Park HS, Yeboa DN, Rutter CE, Corso CD, Aneja S, Lester-Coll NH, Mancini BR, Knisely JP, Yu JB |title=Concurrent chemoradiotherapy versus radiotherapy alone for "biopsy-only" glioblastoma multiforme |journal=Cancer |volume=122 |issue=15 |pages=2364–70 |date=August 2016 |pmid=27172136 |doi=10.1002/cncr.30063 |url=}}</ref>
*** 3.1.1 [[Temozolomide]]
** 3.2 [[Bevacizumab]]<ref name="pmid21135282">{{cite journal |vauthors=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 |title=Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme |journal=J. Clin. Oncol. |volume=29 |issue=2 |pages=142–8 |date=January 2011 |pmid=21135282 |pmc=3058273 |doi=10.1200/JCO.2010.30.2729 |url=}}</ref>
*** A [[Monoclonal antibodies|monoclonal antibody]] which bind to [[VEGF]] and inactivate it.
** 3.3 Alternating electric fields<ref name="pmid22608262">{{cite journal |vauthors=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 |title=NovoTTF-100A versus physician's choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality |journal=Eur. J. Cancer |volume=48 |issue=14 |pages=2192–202 |date=September 2012 |pmid=22608262 |doi=10.1016/j.ejca.2012.04.011 |url=}}</ref>
*** 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<ref name="pmid12672279">{{cite journal |vauthors=Westphal M, Hilt DC, Bortey E, Delavault P, Olivares R, Warnke PC, Whittle IR, Jääskeläinen J, Ram Z |title=A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma |journal=Neuro-oncology |volume=5 |issue=2 |pages=79–88 |date=April 2003 |pmid=12672279 |pmc=1920672 |doi=10.1093/neuonc/5.2.79 |url=}}</ref>
*** Implanted at the time of [[surgery]].
*** Can be used in combination with [[chemotherapy]] or [[radiation]].
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Neurosurgery]]
[[Category:Neurosurgery]]
[[Category:Pathology]]
[[Category:Pathology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 19:19, 14 January 2019

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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



References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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)
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.

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