How are astrocytomas treated?

Neurosurgery (complete or total resection)

Where possible, treatment for grade one and two astrocytomas in adults is normally surgery to remove as much of the tumour as possible – depending on the location.

If the tumour is completely removed, no more treatment may be necessary. You will continue to be monitored with regular MRI scans and treatment will only be given if your symptoms worsen, you develop new symptoms or your scan shows the tumour growing. 

This is often called watch and wait.

Watch and wait

In some cases, your medical team may decide not to use surgery initially, but to use the watch & wait approach instead.The reason for adopting this approach may be that surgery carries more risks than giving no initial treatment. This may be used if the tumour is:

• growing very slowly

• not causing any symptoms or causing only a few symptoms that aren’t affecting your quality of life.
  

It may feel like your medical team aren’t doing anything. But, they will monitor your tumour and, where necessary, treat any symptoms.

In this situation, treatment may not be needed for many months or even years. Some people may never need any further treatment.

Neurosurgery (partial resection or debulking)

In some cases, complete removal of the tumour may not be possible, either because it’s located in a difficult area of the brain to operate on or near parts of the brain where surgery could do more harm than good.

This is more likely in grade two astrocytomas because the edges of the tumour aren’t well-defined and complete removal is often not possible.

Instead, the surgeon will remove as much of the tumour as they can and any following treatment will depend on how much of the tumour is removed. 

If you’ve been diagnosed with a grade one astrocytoma, you may be put on a watch and wait approach after surgery.

Alternatively you may be given radiotherapy after your surgery to treat the remaining tumour cells. This is particularly likely if you’ve been diagnosed with a grade two astrocytoma. 

Occasionally chemotherapy may also be given to treat the remaining tumour cells.

Further surgery may be needed later to remove the remaining tumour or if it starts to regrow. You may also need further surgery to insert a shunt if the tumour is blocking the flow of the cerebrospinal fluid, a condition called hydrocephalus.

Radiotherapy

Radiotherapy uses controlled doses of invisible, high energy beams of charged particles to destroy tumour cells whilst causing as little damage as possible to surrounding cells. It’s often used to treat tumour cells that weren’t possible to remove during surgery. 

Again, this is more likely to be needed with Grade 2 tumours.

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

For children, chemotherapy is often the first line of treatment.

Chemotherapy treatment plans vary enormously and your child’s chemotherapy will be carefully planned and tailored to them individually. As a result, it could vary from daily chemotherapy for a while, as a day case in hospital, to being admitted to the ward for several days every two to three weeks.

As these tumours are faster growing and more aggressive, the usual course of treatment is surgery followed by radiotherapy and sometimes chemotherapy.

Neurosurgery

Where possible, initial treatment is normally surgery to remove as much of the tumour as possible – depending on the location. Complete removal is often not possible, which means tumour cells remain in the brain. Therefore, surgery is often followed up with radiotherapy.

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.

Radiotherapy uses controlled doses of invisible, high energy beams of charged particles to destroy tumour cells whilst causing as little damage as possible to surrounding cells.

Radiotherapy is very rarely used in children under 3 years.

Chemotherapy

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

Chemotherapy treatment plans vary enormously and your child’s chemotherapy will be carefully planned and tailored to them individually. As a result, it could vary from daily chemotherapy for a while, as a day case in hospital, to being admitted to the ward for several days every two to three weeks.

As these tumours are faster growing and more likely to spread, the usual course of treatment is surgery followed by radiotherapy and sometimes chemotherapy. Radiotherapy is very rarely used in children under 3 years.

Currently, the best treatment for grade four astrocytomas (known as glioblastomas) is surgery to remove as much of the tumour as possible, followed by a combination of chemotherapy and radiotherapy