Anaplastic Astrocytomas are among the most common
Primary Malignant Brain Tumors. These tumors represent
approximately one third of all Astrocytomas and about
one quarter of all Gliomas. They occur at any age
but typically are found in older patients. Their peak
incidence is in the fifth and sixth decades of life.
Malignant Astrocytomas generally have a poor prognosis,
with an average survival of two (2) years. Both types of
malignant Glial tumors (Anaplastic Astrocytomas and Glioblastomas)
spread through the extracellular space and along the compact white
matter tracts that connect each part of the Brain with every other
part of the Brain.
Seizures and focal neurological deficits are common
presenting symptoms. In addition, any of the symptoms described
previously, may be present at the time of diagnosis.
MRI Scan is the single most useful Neuroimaging study. It
provides detailed information about the size, location and gross
architectural features of these tumors as well as identifying
the extent of Cerebral Edema (swelling) and effect upon the
surrounding Brain tissue.
Surgery to reduce the bulk of the tumor, followed by Radiation
Therapy, has become the standard against which other treatments are
compared. One must consider that these tumors cannot
usually be cured with surgery alone, although the
Neurosurgeons of Neurosurgical Consultants are encouraged by their
increasing experience with long term survival using a combination
of aggressive approaches. The goals of treatment, if "cure"
is not possible, should be to prolong survival, together with a higher
quality of life.
Because of the infiltrative nature of Astrocytoma,
it is unlikely that surgery will ever be the single definitive
treatment for these neoplasms. However, increasingly
safe and aggressive tumor resection is possible with the advent of
technological advances such as intra-operative MRI and Ultrasonic
imaging systems, as well as, actual tumor-brain interface
"visualization", using Fluorescence-guided resection
FLUORESCENCE is one of the most advanced concepts for the
surgical management of an infiltrative Brain tumor and the ONLY METHOD
that permits the Neurosurgeon to visually identify the tumor that
infiltrates Brain tissue. This technique (developed primarily in
Europe) involves the ingestion of a medication (5-aminolevulinic acid
or "ALA" dissolved in water) that is taken up in certain molecules
of the tumor which when subjected to a special violet-blue light
beamed through the Neurosurgical Operating Microscope actually
("lights up") glows.
The Neurosurgeons of Neurosurgical Consultants firmly believe that
aggressive resection of the tumor, is the first definitive step in the
treatment of these tumors. Other steps include Chemotherapy and
Radiation Therapy. Some additional technologies have also helped to
improve their outcomes. For example,
it is now possible to grow cultures of the
tumor and subject these in the laboratory to sensitivity testing
against various chemotherapy agents prior to initiating Chemotherapy
in a clinical setting.
Traditional management has been to use "standard" forms of
chemotherapy. Currently there are some unconventional
chemotherapeutic alternatives that offer considerable hope for
improved quality and length of survival. New therapies such as
Temodar (temozolamide), Avastin (bevacizumab which is an
anti-angiogenesis medication) and CPT-11 are currently being
used by one of our
Preliminary results have been encouraging. The reader may wish to view
website for additional information.
In some tumor cases we choose to place a special chamber called an
"Ommaya Reservoir" under the scalp, with an attached catheter
residing in the "bed" of the tumor, after resection has been completed.
This permits the Neuro-oncologist to instill chemotherapeutic
medications directly into the tumor bed. This is a far more
effective methodology than placing "chemotherapy wafers in the tumor
Radiation therapy continues to have an important place in the
treatment of many of these tumors. Refinements have been made that
make this treatment less toxic than in previous years.
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This page last edited on 2/19