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Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Management of Specific Tumor Types and Locations

Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)

Brain Stem Gliomas

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Histopathologic Classification of Childhood Craniopharyngioma

Craniopharyngiomas are histologically benign and do not metastasize to remote brain locations or to areas outside the sellar region except by direct extension. They may be invasive, however, and may recur locally. They may be classified as adamantinomatous or squamous papillary, with the former being the predominant form in children.[1] They are typically composed of both a solid portion with an abundance of calcification, and a cystic component which is filled with a dark, oily fluid. Recent evidence...

Read the Histopathologic Classification of Childhood Craniopharyngioma article > >

Standard treatment options:

Brain stem gliomas have relatively poor prognoses that correlate with histology (when biopsies are performed), location, and extent of tumor. The overall median survival time of patients in studies has been 44 to 74 weeks.

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with adult brain stem glioma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

Pineal Astrocytic Tumors

Standard treatment options:

  1. Surgery plus radiation therapy for patients with pilocytic or diffuse astrocytoma.
  2. Surgery plus radiation therapy and chemotherapy for patients with higher grade tumors.

Depending on the degree of anaplasia, pineal astrocytomas vary in prognoses. Higher grades have worse prognoses.

Pilocytic Astrocytomas

Standard treatment options:

  1. Surgery alone if the tumor is totally resectable.
  2. Surgery followed by radiation therapy to known or suspected residual tumor.

This astrocytic tumor is classified as a World Health Organization (WHO) grade I tumor and is often curable.

Diffuse Astrocytomas

Standard treatment options:

  • Surgery plus radiation therapy; however, some controversy exists. Some physicians treat these patients with surgery alone if the patient is younger than 35 years and if the tumor does not contrast-enhance on a computed tomographic (CT) scan.[1]

This WHO grade II astrocytic tumor is less often curable than pilocytic astrocytoma.

Anaplastic Astrocytomas

Standard treatment options:

  1. Surgery plus radiation therapy.
  2. Surgery plus radiation therapy and chemotherapy.

Anaplastic astrocytomas (WHO grade III) have a low cure rate with standard local treatment. Because anaplastic astrocytomas represent less than 10% of all central nervous system gliomas, phase III randomized trials restricted to them are not practical. However, because they are aggressive and often included in studies along with glioblastomas, they are generally managed the same way as glioblastomas, with surgery and radiation, and often with chemotherapy even though it is not known whether the improved survival with chemotherapy in glioblastoma can be extrapolated to anaplastic astrocytomas.

Postoperative radiation alone has been compared to postoperative chemotherapy alone in patients with anaplastic gliomas (i.e., 144 astrocytomas, 91 oligoastrocytomas, and 39 oligodendrogliomas) with crossover to the other modality at the time of tumor progression. One hundred thirty-nine patients were randomly assigned to radiation therapy, and 135 were randomly assigned to chemotherapy with a 32-week course of either procarbazine + lomustine + vincristine (PCV) or single-agent temozolomide (2:1:1 randomization). The order of the modalities did not affect time to treatment failure (TTF) or OS.[2][Levels of evidence: 1iiA and 1iiD] Neither TTF nor OS differed across the treatment arms.

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