Anaplastic Astrocytoma

Anaplastic Astrocytoma – Treatment Overview

Introduction
Anaplastic astrocytoma is a high-grade (WHO Grade III) malignant glioma that arises from astrocytes, the star-shaped glial cells in the brain. It typically affects adults between ages 30–50, though it can occur at any age. This tumor is more aggressive than low-grade astrocytomas but less malignant than glioblastoma (WHO Grade IV). Clinical presentation depends on tumor location and may include headaches, seizures, focal neurological deficits, cognitive or personality changes, and signs of raised intracranial pressure.

Management requires a multimodal approach, combining surgery, radiotherapy, and chemotherapy, with treatment tailored to tumor genetics (e.g., IDH mutation status, MGMT promoter methylation, 1p/19q codeletion).

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Treatment Options

1. Surgery

• Maximal safe resection is the first step when feasible.

• Aim is to reduce tumor burden and improve symptom control.

• If resection is not possible due to tumor location, a stereotactic biopsy is performed for diagnosis.

2. Radiotherapy

• Standard dose: 54–60 Gy in 1.8–2 Gy fractions over 6 weeks.

• Postoperative radiotherapy is recommended in nearly all patients.

3. Chemotherapy

• Temozolomide (oral alkylating agent):

  • Commonly given concurrently with radiotherapy and as adjuvant therapy.

  • Dose: 75 mg/m² daily during radiotherapy; then 150–200 mg/m² for 5 days every 28 days for 6–12 cycles.

• Procarbazine, Lomustine (CCNU), and Vincristine (PCV regimen): May be used as an alternative, especially in tumors with 1p/19q codeletion.

4. Targeted and Experimental Therapies

• Clinical trials may include IDH inhibitors, immunotherapy, and novel targeted agents.

• Molecular profiling helps guide treatment decisions.

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Supportive Care

• Corticosteroids (e.g., dexamethasone): Reduce cerebral edema and symptoms of raised intracranial pressure.

• Antiepileptic drugs: For patients with seizures (levetiracetam preferred).

• Rehabilitation services: Physical, occupational, and speech therapy for neurological deficits.

• Psychological support and palliative care: Essential for quality of life.

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Prognosis

• Median survival: 2–3 years, depending on extent of resection and molecular characteristics.

• Better prognosis with IDH mutation and MGMT promoter methylation.

• Progression to glioblastoma is common.