Astrocytomas

• Pilocytic Astrocytoma: A well-circumscribed, slow-growing tumor; most commonly found in the cerebellum; does not spread to surrounding brain tissue; is considered cured when resected (removed) completely; does not require either chemotherapy or radiotherapy.
• Pleomorphic Xantoastrocytoma: Most often develops in the temporal lobes; commonly associated with seizures; the tumor cells can have many different shapes (pleomorphic), but generally do not show evidence of proliferation; usually curable with surgery.
• Subependymal Giant Cell Astrocytoma (SEGA): More common in younger patients and usually develops in association with the genetic syndrome tuberous sclerosis; develops inside the ventricles, which are cerebrospinal fluid-filled spaces deep inside the brain; can block the normal outflow of cerebrospinal fluid to cause hydrocephalus. Surgical resection is usually curative.

Diffuse Astrocytoma: An invasive tumor with no clear separation from surrounding brain tissue; surgery itself may not be enough to cure it; tumor tissue appears similar to normal brain tissue, but cells appear abnormal under the microscope.

Anaplastic Astrocytoma: A more malignant evolution of a previously lower grade astrocytoma with more aggressive features, including faster growth and more invasion into surrounding areas of the brain; displays a higher degree of cellular abnormalities and evidence of cell proliferation (mitoses) in comparison to grade 2 astrocytomas; surgery is never considered curative for these tumors and must be followed with radiation usually combined with chemotherapy.

Glioblastoma: Also known as glioblastoma multiforme (GBM), glioblastoma is the most aggressive form of astrocytoma and the most common type of astrocytoma diagnosed in adults. It is characterized by very abnormal-looking cells, high cell proliferation (mitoses), areas of dead tissue and the formation of new blood vessels. Glioblastoma can develop from a previously existing lower grade astrocytoma (about 10% of cases) or originate directly as a grade 4 tumor (90% of cases). The former scenario occurs more often in younger individuals, while the latter is most prevalent in people age 60 and older.

Surgery may be used in both the diagnosis and treatment of astrocytomas. Surgical removal of the tumor helps reduce pressure on nearby parts of the brain. Surgery may be followed by chemotherapy or a combination of chemotherapy and radiation therapy.

Working closely with specialists from University Hospitals Neurological Institute’s Brain Tumor and Neuro-Oncology Center our fellowship-trained neurosurgeons utilize the latest advances in surgical intervention to treat astrocytomas, including:

• Minimally invasive brain tumor surgery: This approach includes endoscopic techniques through which our neurosurgeons view detailed images of the patient’s brain using a small camera.
• Fluorescence-guided surgery: UH Seidman Cancer Center neurosurgeons have pioneered use of special fluorescent markers (such as 5-ALA) to assist in precisely identifying the borders of a tumor in order to help the surgeon remove more of it while minimizing risk to the brain.
• NeuroBlate®: This revolutionary laser interstitial thermal therapy destroys brain tumor tissue with a magnetic resonance imaging (MRI)-guided laser. Our hospital is one of only a handful in the world that offers this minimally invasive treatment, which can be used to treat brain tumors that were previously diagnosed as untreatable.
• Intraoperative MRI: At out specialized intraoperative MRI suites, we utilize magnetic resonance imaging to track surgical progress in real-time.

Radiation therapy involves the use of high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. Using a machine outside the body, external radiation therapy sends radiation directly toward the area of the tumor. This therapy is often recommended after surgery and may be administered in combination with chemotherapy. For patients who can’t undergo surgery, radiation therapy and chemotherapy may be used as a primary treatment.

Innovative radiation technologies that we use in the treatment of astrocytomas include:

• Proton therapy: UH Seidman Cancer Center is the first hospital in Northeast Ohio to offer this innovative, powerful and technologically advanced therapy. Effective for both adults and children, proton therapy has less side effects than other forms of radiation therapy, resulting in better quality of life during treatment, while also reducing patient risk for the development of radiation-induced secondary cancers decades after treatment.

Radiation therapy involves the use of high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. Using a machine outside the body, external radiation therapy sends radiation directly toward the area of the tumor. Stereotactic radiosurgery differs from traditional radiation therapy in that stereotactic radiosurgery involves the use of precisely focused radiation beams. Unlike traditional radiation therapy, stereotactic radiosurgery exposes very little if any normal tissue to radiation.

Stereotactic radiosurgery is often recommended after conventional surgery and may be administered in combination with chemotherapy. For patients who can’t undergo conventional surgery, stereotactic radiosurgery and chemotherapy may be used as a primary treatment.

Innovative stereotactic radiosurgery technologies we use in the treatment of astrocytomas include:

• Gamma Knife®: An accurate form of stereotactic radiosurgery for the brain, this technology pinpoints a single area with numerous gamma radiation beams without damaging surrounding healthy tissue.
• Varian Edge™: This advanced, high-focus radiation beam radiosurgery system targets the DNA in cancer cells, destroying the cells. Unlike other radiosurgery systems that require the use of a rigid frame to secure a brain cancer patient’s skull during treatment sessions that can last several hours, Varian Edge delivers equally precise treatment without requiring a frame in as little as just a few minutes.

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or preventing their division. When appropriate, your surgeon may use an innovative technique in which thin, circular wafers containing chemotherapy medicine are placed in the brain during surgery. These wafers dissolve slowly to provide the timed release of a medicine that kills cancer cells.

TTF utilizes an electrical field to impede the ability of a tumor’s cells to multiply. In TTF, adhesive pads connected to a portable device that generates an electrical field are applied to the patient’s scalp. This therapy is combined with chemotherapy and may be suitable following radiation therapy.

Targeted therapy is an approach to treatment that utilizes drugs or other substances to identify and attack specific cancer cells. In general, targeted therapies cause less harm to normal cells than chemotherapy or radiation therapy. Promising targeted therapies for the treatment of astrocytomas include monoclonal antibody therapy, tyrosine kinase inhibitor therapy and vascular endothelial growth factor (VEGF) inhibitor therapy.