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Brain Cancer Health Center

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Childhood Astrocytomas Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment of Childhood Low-Grade Astrocytomas

To determine and implement optimal management, treatment is often guided by a multidisciplinary team of cancer specialists who have experience treating childhood brain tumors.

In infants and young children, low-grade astrocytomas presenting in the hypothalamus make surgery difficult; consequently, biopsies are not always done. This is especially true in patients with neurofibromatosis type 1 (NF1).[1] When associated with NF1, tumors may be of multifocal origin.

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For children with low-grade optic pathway astrocytomas, treatment options should be considered not only to improve survival but also to stabilize visual function.[2,3]

Treatment of Newly Diagnosed Childhood Low-Grade Astrocytomas

Standard treatment options for newly diagnosed childhood low-grade astrocytomas include the following:

  1. Observation.
  2. Surgery.
  3. Adjuvant therapy.


Observation is an option for patients with NF1 or nonprogressive masses.[4,5,6,7] Spontaneous regressions of optic pathway gliomas have been reported in children with and without NF1.[8,9,10]


Surgical resection is the primary treatment for childhood low-grade astrocytoma [1,4,5,11] and surgical feasibility is determined by tumor location.

  • Cerebellum: Complete or near-complete removal can be obtained in 90% to 95% of patients with pilocytic tumors that occur in the cerebellum.[11]
  • Optic nerve: For children with isolated optic nerve lesions and progressive symptoms, complete surgical resection, while curative, generally results in blindness in the affected eye.
  • Midline structures (hypothalamus, thalamus, brain stem, and spinal cord): Low-grade astrocytomas that occur in midline structures can be aggressively resected, with resultant long-term disease control;[8,9,12]; [13][Level of evidence: 3iiiA] however, such resection may result in significant neurologic sequelae, especially in children younger than 2 years at diagnosis.[8]; [14][Level of evidence: 3iC] Because of the infiltrative nature of some deep-seated lesions, extensive surgical resection may not be appropriate and biopsy only should be considered.[15][Level of evidence: 3iiiDiii]
  • Cerebrum: Circumscribed, grade I hemispheric tumors are often amenable to complete surgical resection.[16]
  • Diffuse: Diffuse astrocytomas may be less amenable to total resection, and this may contribute to the poorer outcome.
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