• Anaplastic Astrocytoma

    Anaplastic astrocytomas are brain tumors that arise from brain cells called astrocytes, which are a type of glial cell. An anaplastic astrocytoma is both a type of astroctyoma and a type of high-grade glioma.

    • Anaplastic astrocytoma and glioblastoma multiforme (GBM) are both high-grade gliomas and together account for approximately 10 percent of pediatric brain tumors.
    • Anaplastic astrocytoma occurs with increased frequency in families with neurofibromatosis type I, Li-Fraumeni syndrome, hereditary nonpolyposis colon cancer and tuberous sclerosis.
    • Approximately 65 percent of anaplastic astrocytoma tumors arise in the cerebral hemispheres, the top part of the brain. About 20 percent occur in the area of the thalamus and hypothalamus or the diencephalon, the area responsible for identification of sensation, such as temperature, pain and touch, regulation of appetite/weight and body temperature, as well as connecting the brainstem to the cortex. Another 15 percent can occur in the region of the cerebellum and brain stem known as the posterior fossa.
    • The median age at diagnosis of anaplastic astrocytoma is 9 to 10 years old.

    Anaplastic Astrocytoma Treatment at Dana-Farber/Boston Children’s

    Children with anaplastic astrocytoma are treated at Dana-Farber/Boston Children's through our Glioma Program, one of the world's largest treatment programs focused on pediatric gliomas. Our glioma specialists have extensive expertise in treating all types of gliomas, including anaplastic astrocytoma. Our patients receive multidisciplinary care from neuro-oncologists, neurosurgeons, neurologists, and pediatric subspecialists.

    What causes anaplastic astrocytoma?

    Most anaplastic astrocytomas and high-grade gliomas occur sporadically or without identifiable cause. They do, however, occur with increased frequency in families with the following conditions.

    • neurofibromatosis type I
    • Li-Fraumeni syndrome
    • hereditary nonpolyposis colon cancer
    • tuberous sclerosis

    Anaplastic astrocytomas have also been associated with exposure to vinyl chloride and to high doses of radiation therapy to the brain. 

    What are anaplastic astrocytoma symptoms?

    Anaplastic astrocytomas of the cerebral hemispheres and the diencephalon (also called supratentorial anaplastic astrocytomas) produce a variety of symptoms as a result of increased pressure within the head, as well as more localizing symptoms related to their specific location, rate of growth and associated inflammation.

    The duration of symptoms varies from slow, subtle onsets to more abrupt presentations. Each child may experience different symptoms. The following are the most common anaplastic astrocytoma symptoms:

    • headache and lethargy
    • symptoms of increased pressure within the brain, including:
      • headache (generally upon awakening in the morning).
      • vomiting
      • seizures
    • compression of surrounding brain structures; depending on the location of the tumor, increased pressure can cause:
      • weakness and other motor dysfunction neuroendocrine abnormalities
      • changes in behavior or thought processes

    The symptoms of a brain tumor may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

    How is an anaplastic astrocytoma diagnosed?

    Anaplastic astrocytomas are diagnosed using a combination of tests including:

    • physical examination, including neurologic function tests of reflexes, muscle strength, eye and mouth movement, coordination and alertness.
    • computerized tomography scan (also called a CT or CAT scan) to capture a which detailed view of the body and to assess the density of tumor tissue versus normal brain. This scan can also tell us if the tumor is creating pressure and causing damage to normal brain tissue taking.
    • magnetic resonance imaging (MRI) to produce detailed images of organs and structures within the body and/or spine. MRI provides greater anatomical detail than CT scan and can better distinguish between tumor, tumor-related swelling and normal tissue. In addition, MRI can distinguish between a hemorrhage and a tumor cyst.
    • magnetic resonance spectroscopy (MRS), which is done along with MRI to detect the presence of particular organic compounds produced by the body’s metabolism. This also helps us qualify tissue as normal or tumor, and may be able to help us determine where the tumor tissue originated.
    • biopsy to collection of a tissue sample either through a needle or during surgery performed by a pediatric neurosurgeon to confirm the diagnosis.

    What are the anaplastic astrocytoma treatments?

    The primary treatment for newly diagnosed anaplastic astrocytoma is maximal surgical removal, when possible, followed by radiation therapy. To date, no chemotherapy regimen has been demonstrated to increase survival in pediatric high-grade gliomas.

    As with all pediatric cancers, care should be delivered at a specialized center where multidisciplinary teams can provide not only expert diagnostics and experienced medical, surgical and radiation oncologists, but also psychosocial support, neuro-psychological testing and specialized school plans all delivered in a child- and family-sensitive and friendly environment.

    Anaplastic astrocytoma treatment may include (alone or in combination):

    • Neurosurgery: The first treatment is usually surgery to remove as much of the tumor as possible, ideally using advanced techniques to maximize tumor removal, such as intraoperative MRI (in which surgeons can visualize the tumor as they operate). Complete resection, or surgical removal, of the entire tumor is ideal when possible, though most high-grade gliomas cannot be completely removed because they tend to infiltrate into adjacent healthy tissues. In general, the more completely the tumor can be removed, the greater the chances for survival.
    • Radiation: High-energy waves from a specialized machine damage or shrink tumors. Your child also may receive precisely targeted and dosed radiation to kill cancer cells left behind after surgery. This is important to control the local growth of tumor, and it helps increase survival in high-grade gliomas.
    • Chemotherapy: Chemotherapy refers to drugs that interfere with the cancer cells' ability to grow or reproduce. To date, no chemotherapy regimen has been demonstrated to increase survival rates in children with GBM, though chemotherapy before surgery may help shrink the tumor, making it possible to remove. A variety of chemotherapy regimens have been tested in the treatment of newly diagnosed high-grade gliomas, and some have produced responses but none have improved survival. Studies in adults have suggested that certain drugs can produce modest responses in high-grade gliomas, but they have less effect in children. High-intensity chemotherapy in conjunction with a stem cell transplant also does not seem to improve chances of survival.

    What is the latest anaplastic astrocytoma research?

    Clinical and basic scientists at Dana-Farber/Boston Children’s are conducting numerous research studies to help clinicians better understand and treat malignant gliomas. Through the consortia of researchers to which we belong, a number of novel therapies are available for children with both newly diagnosed and current brain tumors. Participation in any clinical trial is completely voluntary. We will take care to fully explain all elements of the treatment plan prior to the start of the trial, and you may remove your child from the medical study at any time.

    Clinical Trials

    For many children with brain tumors or other rare or hard-to-treat conditions, clinical trials provide new options.

    It’s possible that your child will be eligible to participate in one of our brain tumor clinical trials. In addition to launching our own clinical trials, we also offer trials available through collaborative groups such as the Children's Oncology Group (COG), the Pacific Pediatric Neuro-Oncology Consortium (PNOC). If your child has progressive or recurrent tumor, she may be eligible for a number of experimental therapies available through these groups, or from one of our independent clinical investigators.

    What is the long-term outlook for children with anaplastic astrocytoma?

    Unfortunately, the prognosis for anaplastic astrocytoma remains poor. In general, more complete surgical removal of the tumor, when possible, results in greater chance of survival. Your child’s doctor will discuss treatment options with you, including experimental clinical trials and supportive care.

    For children with relapsed anaplastic astrocytomas, we offer access to the latest clinical trials and experimental therapies. Current trials include novel medications, as well as new methods for the delivery of more traditional agents.

    Our Pediatric Advanced Care Team (PACT) is available to provide supportive treatments intended to optimize your child’s quality of life and promote comfort and healing for children with life-threatening illnesses. In addition, PACT can provide psychosocial support and help arrange end-of-life care, when necessary.

    Children successfully treated for anaplastic astrocytoma should visit a cancer survivorship clinic yearly to manage disease complications, screen for recurrence and manage late treatment side effects. A typical follow-up visit is likely to include a physical exam, laboratory testing and imaging scans.

    Through our Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic, children are able to meet with their neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit. Our multidisciplinary approach and depth of expertise will give your child on-site access to endocrinologists, neuro-psychologists and alternative/complementary therapy specialists. School liaison and psychosocial personnel from the pediatric brain tumor team are also available. In addition, children needing rehabilitation may meet with speech, physical, and occupational therapists during and after their visit.