eMedicine Specialties > Oncology > Carcinomas of the Central and Peripheral Nervous System

Astrocytoma: Follow-up

Author: Benjamin Kennedy,, Columbia University College of Physicians and Surgeons
Coauthor(s): Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons
Contributor Information and Disclosures

Updated: Jan 23, 2009

Follow-up

Further Inpatient Care

  • Management of low-grade astrocytomas is controversial. The tumors may be radiographically stable and clinically quiescent for long periods after the initial presentation.
  • Therapeutic options include observation, radiation, and resection with and without radiation. Unless an astrocytoma is resected completely, radiation therapy should be considered.
  • In higher-grade lesions, even if gross total resection is confirmed radiographically, postoperative radiation is indicated because microscopic disease remains.
  • If no resection is undertaken and radiation is contemplated, a stereotactic biopsy is recommended to establish the histological grade of the tumor definitively.

Further Outpatient Care

  • Patients should consult a neurologist to observe the progression of neurological signs and symptoms and to manage steroid and anticonvulsant regimens.
  • Outpatient neurosurgery observation is necessary for tumor monitoring and management of hydrocephalus if a shunt has been placed.
  • Postoperative and postirradiation chemotherapy trials using nitrosourea and other agents are likely to benefit patients with malignant astrocytomas, but the benefit for patients with well-differentiated astrocytomas is questionable.
  • Frequency of postoperative MRI is determined by both the neurosurgeon and other physicians involved in the ongoing care of the patient, including the neurooncologist and radiation oncologist.

Inpatient & Outpatient Medications

  • Corticosteroids, antiepileptic agents, and GI prophylaxis should be employed.

Transfer

  • If surgery is anticipated, patients should be transferred to institutions with an appropriately equipped and adequately staffed neurosurgical intensive care unit for postoperative monitoring.
  • Patients may require extensive or focused postoperative rehabilitation that may necessitate transfer to specialized institutions dedicated to physical and occupational therapy.

Complications

  • Although neurological injury (potentially devastating) and death must be mentioned, neurosurgery for astrocytomas is generally intended to decrease tumor bulk while avoiding permanent neurological injury. Transient deficits due to local swelling or injury may occur, but they often improve after a course of physical therapy and rehabilitation.

Prognosis

  • Prognosis for survival after operative intervention and radiation therapy can be favorable for low-grade astrocytomas.
  • For those patients who undergo surgical resection, the prognosis depends on whether the neoplasm progresses to a higher-grade lesion.
  • For low-grade lesions, the mean survival time after surgical intervention has been reported as 6-8 years.
  • In the case of anaplastic astrocytoma, symptomatic improvement or stabilization is the rule after surgical resection and irradiation. High-quality survival is observed in 60-80% of these patients. Factors such as youth, functional status, extent of resection, and adequate irradiation affect the duration of postoperative survival.
  • Recent reports indicated that irradiation of incompletely resected tumors increased 5-year postoperative survival rates from 0-25% for low-grade astrocytomas and from 2-16% for anaplastic astrocytomas. Furthermore, the median survival rate of patients with anaplastic astrocytoma who undergo both resection and irradiation has been reported to be twice that of patients receiving only operative therapy (5 y vs 2.2 y).

Miscellaneous

Medicolegal Pitfalls

  • Failure to make an appropriate diagnosis of astrocytoma is a pitfall that should be avoided by adhering to a systematic diagnostic approach, including imaging studies and obtaining adequate tissue for analysis.
  • Timing of diagnosis is particularly important when lesions abut crucial brain nuclei or eloquent cortex. The extent of lesion resectability may be affected by delay.
  • Clear explanation of all therapeutic options and prognosis is essential once a diagnosis is established.
 
Acknowledgments

We wish to acknowledge previous contributions to this chapter from Patrick Senatus, MD, PhD and Allen Waziri, MD.



More on Astrocytoma

Overview: Astrocytoma
Differential Diagnoses & Workup: Astrocytoma
Treatment & Medication: Astrocytoma
Follow-up: Astrocytoma
Multimedia: Astrocytoma
References
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Further Reading

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Keywords

low-grade astrocytoma, fibrillary astrocytoma, gemistocytic astrocytoma, protoplasmic astrocytoma, diffuse astrocytoma, pilocytic astrocytoma, pilocystic astrocytoma, juvenile pilocytic astrocytoma, anaplastic astrocytoma, glioblastoma multiforme, CNS neoplasm, CNS cancer, CNS malignancy, immortalized astrocyte

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Contributor Information and Disclosures

Author

Benjamin Kennedy,, Columbia University College of Physicians and Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons
Jeffrey N Bruce, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Neurological Surgeons, Congress of Neurological Surgeons, New York Academy of Sciences, North American Skull Base Society, Society for Neuro-Oncology, and Southwest Oncology Group
Disclosure: NIH Grant/research funds Other

Medical Editor

Robert C Shepard, MD, FACP, Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International
Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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