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Anaplastic Astrocytoma

  • NEURO-ONCOLOGY (NEOPLASMS) (MR ROSENFELD, SECTION EDITOR)
  • Published:
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Opinion statement

Standard treatment of anaplastic astrocytoma (AA) in good performance patients consists of maximal safe surgical resection followed by focal, fractionated, external beam radiotherapy (RT) alone or in combination with concurrent and adjuvant temozolomide (TMZ). Since prospective data regarding the use of chemoradiotherapy for AA is lacking, the practice is based on the extrapolation of results from a randomized study in glioblastoma (GB). Whether the data from the GB study can and should be extrapolated is controversial, although a large multicenter, randomized, phase III study is underway to define optimal initial AA treatment. Patients should be tapered off corticosteroids completely or to the lowest dose necessary to treat neurologic dysfunction. Anti-epileptic drugs (AED) are not indicated unless there is a history of seizure; levetiracetam is the preferred AED in malignant glioma (MG). Unless there is evidence of intracranial hemorrhage, venous thromboembolism (VTE) should be treated with low-molecular-weight heparin (LMWH) therapy. At recurrence, patients with good performance status are usually treated with cytotoxic chemotherapy following, or in lieu of, repeat surgery. TMZ is the preferred chemotherapeutic agent in patients without prior exposure; lomustine is recommended for tumors resistant to TMZ. In patients with neurologic dysfunction secondary to tumor edema and mass effect who are not amenable to surgery, the use of bevacizumab is associated with improved neurologic function and better quality of life. Given the limited treatment options at tumor recurrence, consideration for enrollment on a clinical trial is encouraged.

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Conflict of Interest

Sean A. Grimm has served on an advisory board and received grant support from Genentech.

Thomas J. Pfiffner declares that he has no conflict of interest.

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  1. Department of Neurology, University of Minnesota School of Medicine, 420 Delaware Street SE, MMC 295, Minneapolis, MN, 55455, USA

    Sean A. Grimm MD & Thomas J. Pfiffner MD

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Grimm, S.A., Pfiffner, T.J. Anaplastic Astrocytoma. Curr Treat Options Neurol 15, 302–315 (2013). https://doi.org/10.1007/s11940-013-0228-7

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