Treatment for glioma (astrocytoma)
This page is about the treatment of gliomas in adults. There is information about
Treatment for glioma
Several brain tumour types are grouped together under the name glioma. This page covers astrocytoma and glioblastoma multiforme in adults. Astrocytomas can be any grade, from very slow growing (grade 1) to very fast growing (grade 4). In terms of treatment they are divided into low grade and high grade.
Low grade astrocytomas
Sometimes these tumours grow very slowly and do not need treatment at first unless they cause symptoms. You may have regular monitoring with MRI scans at first to check how quickly the tumour is growing. If the tumour grows very slowly you may not need treatment for some months or years. If the tumour grows more quickly, surgery is the most important treatment for most people.
Your surgeon will remove all or as much of the tumour as possible – this is known as debulking. Any remaining tumour may then be treated with radiotherapy or possibly chemotherapy. Or your doctor may suggest keeping these treatments in reserve so you can have them if the tumour starts to grow again and causes symptoms.
High grade astrocytomas
This group of gliomas includes anaplastic astrocytomas (grade 3) and glioblastoma multiforme (grade 4). You are most likely to have surgery to remove as much of the tumour as possible, followed by radiotherapy for a few weeks, sometimes with chemotherapy. The treatment aims to try to control the tumour for as long as possible. If you are not fit enough to have a long course of radiotherapy you may be offered a shorter course to treat symptoms or occasionally chemotherapy on its own.
Brain stem glioma
Gliomas can occur in the brain stem but this is very rare. It may be possible to biopsy the tumour but it cannot be removed. The brain stem is too delicate to operate on. The main treatment is radiotherapy to slow the growth of the tumour and reduce symptoms.
Several brain tumour types are grouped together under the name glioma. This includes
This page covers astrocytoma and glioblastoma multiforme in adults. There are separate pages about the treatment of oligodendroglioma and ependymoma. We also have a page about treating gliomas in children because the treatment for young children is different from adults.
Astrocytomas can be any grade, from very slow growing (grade 1) to very fast growing (grade 4). In terms of treatment they are divided into low grade and high grade.
The treatment you will need will depend on
- The grade of your brain tumour
- How much of the tumour your surgeon can remove
- The position of the tumour in the brain
- The effects of the tumour on your health and wellbeing
- Your age – treatment for children may differ and they usually have a better outlook
The treatment for low grade and high grade astrocytomas is discussed in detail below.
Sometimes these tumours grow very slowly and do not need treatment at first unless they cause symptoms.
You may have regular monitoring with MRI scans at first to check how quickly the tumour is growing. Doctors call this watchful waiting. If the tumour grows very slowly you may not need treatment for some months or years. Some older people with very slowly growing tumours may never need any further treatment.
If the tumour grows more quickly, surgery is the most important treatment for most people. Generally about half of the people with low grade tumours are likely to need surgery within the following 2 to 3 years. During surgery your surgeon will remove as much of the tumour as possible and they call this debulking. Sometimes, you swallow a capsule 3 hours before the surgery. This releases a florescent dye called Gliolan (5-ALA) which shows up the border of the tumour and may allow the surgeon to remove more tumour safely.
If the tumour is completely or almost completely removed, you may not need any other treatment. But your hospital team will continue to keep a close eye on you with regular MRI scans. Or your doctor may recommend radiotherapy afterwards. They are more likely to recommend radiotherapy if
- You are over 40
- The tumour left behind is large
- You have symptoms such as weakness of an area of the body
If your tumour cells have a particular gene change called 1p19q your treatment team may recommend chemotherapy first rather than radiotherapy.
Even if some tumour is left behind after surgery, slow growing tumours may take many years to cause symptoms again. Nearly half of all patients with partially removed low grade astrocytomas live for at least 10 years after treatment with surgery and radiotherapy.
This group of gliomas includes anaplastic astrocytomas (grade 3) and glioblastoma multiforme (grade 4). Treatments include
Surgery is usually used to remove as much of the tumour as possible. Your surgeon may ask you to swallow a capsule called Gliolan (5-ALA) a few hours before the operation. The drug in the capsule makes the glioma cells glow (fluoresce) under a blue light and shows the edges (margins) of the tumour very clearly. This may allow the surgeon to remove more of the tumour.
The surgery is often followed by radiotherapy or chemotherapy.
The radiotherapy will not cure the cancer but aims to try to control the tumour for as long as possible. You have treatment from Monday to Friday each week for a few weeks. But if you are not very fit, a long course of radiotherapy may not be suitable for you. Then your treatment team may offer you a shorter course over 2 weeks and you may have treatment every day, or every other day. The aim of the treatment is to slow down the tumour growth and means that it takes longer for the tumour to cause further problems. You and your family will need to talk all this through carefully with your doctors.
Carmustine implants are a type of chemotherapy treatment for newly diagnosed high grade glioma if 90% or more of the tumour can be removed surgically. The carmustine implants (Gliadel) are small chemotherapy wafers about the size of a 5p piece. The surgeon puts them in place during your operation. This should only be done by specialist neurosurgeons in specialist centres, where MRI scans are used to predict if enough of the tumour can be removed. The implants can help some people to live longer but they can also cause uncomfortable side effects.
After removal of a tumour some people who are fairly fit may have temozolomide chemotherapy capsules alongside radiotherapy and for several months afterwards. Or, your doctor may just use radiotherapy and keep the chemotherapy in reserve so that you can have it if the tumour starts to grow again.
Another type of chemotherapy used is PCV, which contains the drugs procarbazine, lomustine (CCNU) and vincristine. You take the CCNU and procarbazine as tablets. You have to go to hospital to have the vincristine by injection into a vein.
Some people have more surgery to remove as much of the tumour as possible. The surgeon may insert carmustine wafers into the area or the tumour. Or you may have radiotherapy, chemotherapy or a combination of treatments.
Gliomas can occur in the brain stem but this is rare. It may sometimes be possible to take a biopsy from the tumour but the tumour cannot be removed. The brain stem is too delicate an area to operate on, so sometimes the surgeon feels it is too risky to even perform a biopsy. In these circumstances your specialist will talk to you about the likely diagnosis based on the MRI scan.
The main treatment for brain stem gliomas is radiotherapy. Unfortunately, this will not get rid of the tumour completely. But it slows down the growth and helps to reduce symptoms in most people.
If you have questions about glioma treatment you may find information in our section about brain tumour treatment.
You can find information about the outlook (prognosis) for these tumours on the brain tumour statistics and outlook page.
You are also welcome to contact the Cancer Research UK nurses on freephone 0808 800 4040. Lines are open from 9am to 5pm, Monday to Friday.
You can contact one of the brain tumour organisations or look at our brain tumour reading list. If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.
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