Adult Brain Tumor Treatment Information for Physicians

Important: This information is intended mainly for use by doctors and other health care professionals. If you have questions about this topic, you can ask your doctor, or call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

ADULT ANAPLASTIC ASTROCYTOMA

For anaplastic astrocytomas of higher grade, the cure rate is low with standard local treatment.[1] These patients are appropriate candidates for clinical trials designed to improve local control by adding newer forms of treatment to standard treatment.

Treatment options:

Standard:

1. Surgery plus radiation therapy.

2. Surgery plus radiation therapy and chemotherapy.[2-4]

Patients with brain tumors that are either infrequently curable or
unresectable should be considered candidates for clinical trials that
evaluate hyperfractionated irradiation, accelerated fraction radiation,
stereotactic radiosurgery, radiosensitizers, hyperthermia, interstitial
brachytherapy, or intraoperative radiation therapy used in conjunction with external-beam radiation therapy to improve local control of the tumor and/or for studies that evaluate new drugs and biological response modifiers following radiation therapy.[5-8] Cooperative group trials that evaluate chemoradiotherapy administered with either hyperfractionated irradiation or a combination of brachytherapy and external-beam irradiation are now in progress.

Carmustine (BCNU) impregnated polymer may be implanted during surgery.[9,10]

1. Nelson DF, Nelson JS, Davis DR, et al.: Survival and prognosis of patients with astrocytoma with atypical or anaplastic features. Journal of Neuro-Oncology 3(2): 99-103, 1985.
2. Rodriguez L, Levin V: Does chemotherapy benefit the patient with a central nervous system glioma? Oncology (Huntington NY) 1(9): 29-36, 1987.
3. Chang CH, Horton J, Schoenfeld D, et al.: Comparison of postoperative radiotherapy and combined postoperative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas: a joint Radiation Therapy Oncology and Eastern Cooperative Oncology Group Study. Cancer 52(6): 997-1007, 1983.
4. Levin VA, Silver P, Hannigan J, et al.: Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. International Journal of Radiation Oncology, Biology, Physics 18(2): 321-324, 1990.
5. Nelson DF, Urtasun RC, Saunders WM, et al.: Recent and current investigations of radiation therapy of malignant gliomas. Seminars in Oncology 13(1): 46-55, 1986.
6. Levin VA: Chemotherapy of primary brain tumors. Neurologic Clinics 3(4): 855-866, 1985.
7. Shapiro WR: Therapy of adult malignant brain tumors: what have the clinical trials taught us? Seminars in Oncology 13(1): 38-45, 1986.
8. Loeffler JS, Alexander E, Shea WM, et al.: Radiosurgery as part of the initial management of patients with malignant gliomas. Journal of Clinical Oncology 10(9): 1379-1385, 1992.
9. Brem H, Piantadosi S, Burger PC, et al.: Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. Lancet 345(8956): 1008-1012, 1995.
10. Brem H, Ewend MG, Piantadosi S, et al.: The safety of interstitial chemotherapy with BCNU-loaded polymer followed by radiation therapy in the treatment of newly diagnosed malignant gliomas: phase I trial. Journal of Neuro-Oncology 26(2): 111-123, 1995.

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