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Treating diffuse astrocytoma

The treatment for astrocytomas depends on the grade of the tumour, as well as its size and location.

Surgery

Surgery is usually the first treatment for grade 2 astrocytomas The aim is to remove as much of the tumour as possible. How much can be removed will depend on where the tumour is in the brain. At this point you may be told about, or may like to ask about 'biomarker testing' and 'biobanking'.

Complete tumour removal

If the tumour is in the cerebrum or cerebellum they can often be removed completely. You may hear this referred to as a 'complete or total resection'.

If the tumour is completely removed, more treatment may not be needed. Your hospital will continue to monitor you with regular MRI scans, with no treatment given, unless you develop symptoms, existing symptoms worsen or your scan shows changes. This is often called 'watch and wait'.

With tumour locations other than the cerebrum or cerebellum, complete removal may still be possible, but the benefits need to be weighed up against various possible after-effects. For example, if the tumour is in the optic nerve, complete removal may be achieved, but it can result in blindness in the affected eye. Or if the tumour is in one of the 'midline structures' (e.g. hypothalamus, brain stem, spinal cord), surgery can affect the functions these areas control, such as breathing, sleep, body temperature, particularly in children younger than 2 years old.

However, as these tumours are more diffuse (less well-defined), complete removal is often not possible. If the tumour cannot be completely removed, the surgeon will remove as much as possible. This is known as 'debulking' or 'partial resection'. This is more likely the case with Grade 2 astrocytomas whose edges are less well defined. These tumours are more likely to regrow so surgery is more often followed up with radiotherapy.

For children, particularly young children, chemotherapy is usually the first treatment given.

Partial tumour removal

In some cases, complete removal of the tumour may not be possible. It may be located in a difficult area of the brain to operate, or near important parts of the brain where surgery could do more harm than good. In this case, the surgeon will remove as much of the tumour as they can. This is known as 'debulking' or 'partial resection'.

Depending on how much of the tumour is removed, you may be put on a 'watch and wait' approach after surgery. Alternatively you may be given radiotherapy after your surgery, though doctors try to avoid this in people with the genetic condition NF1 and also in children under three years old. Occasionally chemotherapy may also be given.

Further surgery may be needed later to remove the rest of the tumour that was left, or if it starts to regrow. You may also need further surgery if the tumour is blocking the flow of the cerebro-spinal fluid (a condition called 'hydrocephalus'), to insert a shunt to remove the excess fluid from the brain.

Radiotherapy

If you are relatively fit, a long course of radiotherapy over several weeks may by suggested. If not, a shorter course may be more suitable. Radiotherapy is very rarely used in children under three years old.

Chemotherapy

Where chemotherapy is suggested, chemotherapy drugs are sometimes put inside a polymer wafer and inserted into the brain during surgery. The polymer gradually dissolves over 2-3 weeks, releasing the chemotherapy drug (usually carmustine) directly into the brain. Wafers are used to target cells which couldn't be removed by surgery. You may also hear these implants referred to as Gliadel® wafers. Find out more about chemotherapy for adults or chemotherapy for children.

Your oncologist may also recommend a drug called temozolomide (Temadol®). Both carmustine and temozolomide stop the tumour cells copying their DNA (genes), which needs to happen before the cells can divide. This in turn stops the tumour cells dividing.

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