Treatment for glioma (astrocytoma)

Several brain tumour types are grouped together under the name glioma. This includes

• Astrocytoma
• Glioblastoma multiforme (or grade 4 astrocytoma)
• Oligodendroglioma
• Ependymoma

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. 

Surgery is the most important treatment for most astrocytomas. Your surgeon will remove all or as much of the tumour as possible - this is known as debulking. Your specialist may suggest that you have any remaining tumour treated with radiotherapy and possibly chemotherapy. Or they may suggest keeping these treatments in reserve so that you can have them if the tumour comes back.

In some cases, for small gliomas that have come back after treatment you may have stereotactic radiotherapy or radiosurgery.

How successful your treatment is depends on

• The grade of your brain tumour
• How much of the tumour your surgeon can remove
• Where in the brain the tumour is
• 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.

If your tumour is very slow growing (grade 1), your specialist may recommend that you do not have surgery straight away. It may be an option to wait and see how fast it develops. There is a chance that you may never need surgery if the growth is really slow, particularly if you are older. But generally about half of the people in this situation are likely to need surgery within the following 2 to 3 years. If the glioma 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. Or your doctor may recommend radiotherapy afterwards. 

Most people with grade 2 astrocytoma have surgery within a few weeks of being diagnosed. This is usually followed by 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. Because a low grade tumour may not cause you further problems, your specialist may suggest keeping radiotherapy in reserve and only using it if the tumour does come back.

If the tumour is deep within the brain or is causing symptoms such as blurred vision, your specialist may recommend that you have chemotherapy.

This group of gliomas includes anaplastic astrocytomas (grade 3) and glioblastoma multiforme (grade 4). To treat these, you are most likely to have surgery to remove as much of the tumour as possible, followed by radiotherapy. The radiotherapy is to try to control the tumour for as long as possible and 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 you may be offered a shorter course of palliative radiotherapy. This means radiotherapy to treat symptoms, rather than to try to cure your brain tumour. You usually have it over 2 weeks and may have treatment every day, or every other day. The treatment may 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.

Your doctor may suggest conformal radiotherapy which shapes the radiation beams to fit the tumour very closely. Conformal radiotherapy uses very advanced radiotherapy planning techniques to give an exact treatment area. This means that the amount of healthy brain tissue exposed to radiation is much smaller than with standard radiotherapy.

Your doctor may suggest chemotherapy as well as radiotherapy under some circumstances. Or they may keep chemotherapy in reserve so that you can have it if the tumour comes back. Chemotherapy does not work for everyone with a glioma. But it helps about half the people treated. You may have chemotherapy after surgery, and during or after radiotherapy when you are first diagnosed. 

The National Institute for Health and Clinical Excellence (NICE) has recommended temozolomide capsules as a possible treatment for newly diagnosed glioblastoma multiforme, but only if you are fit enough to look after yourself. It can also be used for brain tumours that have come back after they were first treated.

NICE have also recommended carmustine implants as a possible treatment for newly diagnosed high grade glioma, if 90% or more of the tumour can be removed surgically. The carmustine implants are small chemotherapy wafers about the size of a 5p piece. They are put in place during your operation. This should only be done by specialist neurosurgeons in specialist centres, where MRI scans can be 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.

Another type of chemotherapy used is PCV, containing 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.

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 an area to operate on. The main treatment in this situation 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.