Anaplastic astrocytomas (World Health Organization grade III) have a low cure rate with standard local treatment.[1] Patients with anaplastic astrocytomas are appropriate candidates for clinical trials designed to improve local control by adding newer forms of treatment to standard treatment. (Refer to the Anaplastic astrocytoma section in the Classification section of this summary for more information.)

STANDARD TREATMENT OPTIONS:

1. Surgery plus radiation therapy.
2. Surgery plus radiation therapy and chemotherapy .[2,3,4,5,6,7]

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• Patients with brain tumors that are either infrequently curable or unresectable should be considered candidates for clinical trials that evaluate hyperfractionated radiation therapy, accelerated-fraction radiation, stereotactic radiosurgery, radiosensitizers, hyperthermia, interstitial brachytherapy, or intraoperative radiation therapy used in conjunction with external-beam radiation therapy (EBRT) to improve local control of the tumor. Such patients are also candidates for studies that evaluate new drugs and biological response modifiers following radiation therapy.[8,9,10,11,12] Cooperative group trials that evaluate chemoradiation therapy administered with either hyperfractionated radiation therapy or a combination of brachytherapy and EBRT are now in progress.
• Carmustine (BCNU)-impregnated polymer may be implanted during surgery.[13,14]

Information about ongoing clinical trials is available from the NCI Web site.

References:

1. Nelson DF, Nelson JS, Davis DR, et al.: Survival and prognosis of patients with astrocytoma with atypical or anaplastic features. J Neurooncol 3 (2): 99-103, 1985.
2. Rodriguez LA, Levin VA: Does chemotherapy benefit the patient with a central nervous system glioma? Oncology (Huntingt) 1 (9): 29-36, 40-1, 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 Group 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. Int J Radiat Oncol Biol Phys 18 (2): 321-4, 1990.
5. Friedman HS, Kerby T, Calvert H: Temozolomide and treatment of malignant glioma. Clin Cancer Res 6 (7): 2585-97, 2000.
6. Prados MD, Levin V: Biology and treatment of malignant glioma. Semin Oncol 27 (3 Suppl 6): 1-10, 2000.
7. Macdonald DR: Temozolomide for recurrent high-grade glioma. Semin Oncol 28 (4 Suppl 13): 3-12, 2001.
8. Nelson DF, Urtasun RC, Saunders WM, et al.: Recent and current investigations of radiation therapy of malignant gliomas. Semin Oncol 13 (1): 46-55, 1986.
9. Levin VA: Chemotherapy of primary brain tumors. Neurol Clin 3 (4): 855-66, 1985.
10. Shapiro WR: Therapy of adult malignant brain tumors: what have the clinical trials taught us? Semin Oncol 13 (1): 38-45, 1986.
11. Loeffler JS, Alexander E 3rd, Shea WM, et al.: Radiosurgery as part of the initial management of patients with malignant gliomas. J Clin Oncol 10 (9): 1379-85, 1992.
12. Yung WK, Prados MD, Yaya-Tur R, et al.: Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol 17 (9): 2762-71, 1999.
13. 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. The Polymer-brain Tumor Treatment Group. Lancet 345 (8956): 1008-12, 1995.
14. 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. J Neurooncol 26 (2): 111-23, 1995.