Anaplastic+Astrocytoma


 * Epidemiology: || Every year an estimated 22,020 adults (11,980 men and 10,040 women)in the United States will be diagnosed with primary malignant tumors of the brain and spinal cord. Brain tumors are the tenth most common cause of cancer death in women. About 4,030 children and teens will be diagnosed with a brain or central nervous system tumor this year. [1]

Anaplastic Astrocytoma, along with glioblastoma and PNET, make up 10% of all brain tumor incidence.[2] || -Headache is most common. -Seizures (supratentorial tumors). -Alterations in personality, mood, mental capacity and concentration. || MRI is superior to CT for detecting and localizing brain tumors because MRI produces images in any plane and promised by bone artifact. On the other hand, CT can better image calcification found in some low-grade gliomas and can distinguish and acute bleed. || Histology: astrocytes with anaplastic features: increased cellularity, pleomorphism, mitotic activity, and nuclear atypia.
 * Etiology: || Genetics are believed to play a role in the incidence of brain tumors. There is an association between hereditary syndromes and brain tumors. Although environmental factors have been linked to the development of brain tumors, they are not responsible for most brain tumors. [3] ||
 * Signs & Symptoms: || The presenting signs and symptoms of Anaplastic Astrocytoma (AA) associates with a mass effect which results from intracranial pressure.
 * Diagnostic Procedures: || Computed Tomotherapy (CT) and magnetic resonance imaging (MRI) play an indispensable role in the management of brain tumors.
 * Histology: || Cell of Origin: ASTROCYTE

|| Metastases rarely arise outside the central nervous system (CNS). || ↓ Anaplastic astrocytoma ↓ Giloblastoma multiform
 * Lymph Node Drainage: || No lymphatic drainage involved. ||
 * Metastatic Spread: || Direct invasion: Tumor enlarges and extends directly into adjacent structures.
 * Grading: || Astrocytoma

World Health Organization (WHO): Anaplastic astrocytoma grade 3 which is highly anaplastic astrocytoma. ||
 * Staging: || The American Joint Committee on Cancer (AJCC) has published a staging system for brain tumor

TMN STAGING OF BRAIN TUMORS: Clinical Classification T Primary tumors TX Primary tumor cannot be assessed T0 No evidence of primary tumor
 * T **


 * Supratentorial tumor **

T1 Tumor 5cm or less in greatest dimension, limited to one side T2 Tumor more than 5 cm in greatest dimension; limited to one side T3 Tumor invades or encroaches on the ventricular system T4 Tumor crosses the midline of the brain, invades the opposite hemisphere, or invades infratentorially


 * Infratentorial tumor **

T1 Tumor 3 cm or less in greatest dimension, limited to one side T2 Tumor more than than 3 cm in greatest dimension; limited to one side T3 Tumor invades or encroaches on the ventricular system T4 Tumor crosses the midline of the brain, invades the opposite hemisphere, or invades supratentorially


 * N Nodal involment **

Not defined for this site


 * M Distant metastases **

MX Presence of distant metastases cannot be assessed M0 No distant metastases M1 Distant metastases || Alopecia Headache Mild headache Nausea Short-term memory declining Hemorrhagic vascular telangiectasia Neurobehavioral impairment Pituitary-hypothalamic dysfunction Focal radiation necrosis Cerebral cortical atrophy Decreased level of intellectual function || The goals of surgery are to establish a tissue diagnosis, to remove as much as tumor as possible without increasing the neurologic deficit. Dose: 60 Gy for 30-33 fractions The initial PTV (PTV1) encompasses the enhancing lesion (GTV) and edema (CTV) with a 2 cm margin. After 45 Gy of a conventionally fractionated treatment course, the PTV (2) is reduced to include only the enhancing lesion with a 2.5 cm margin with 14.4 Gy. Postoperative irradiation has been recommended after complete resection by some. PTV encompasses the T2-weighted MRI-defined GTV with 2 cm margin of normal brain. Organ at risk: Lens, eyes, optic chiasm, optic nerves, brainsterm, cord, mandible. Depend on the location of the tumor, beam arrangement is ultimately decided to spare most adjacent structures such as anterior-lateral, opposed lateral, vertex and ect…. Wedged field is selected to achieve the isodose distributions. Non-coplanar beams are used to provides a uniform dose to the target and acceptable dose gradient at the target edge in order to spare critical structures. Achieving the high conformal dose to PTV. Tumors limit to 3 cm in diameter and need to be sufficiently distant from critical structures so that these structures are not included in the high-dose volume. SRS: Highly focal delivery of large single radiation doses (10 Gy -20 Gy). SRT: 25 Gy in five consecutive daily fractions. || References: [1] Cancer.net. Brain Tumor. Available at: []. Accessed on June 1, 2011. [2] Washington C, Leaver D. Pediatric Solid Tumors. //Principles and Practice of Radiation Therapy. 2nd ed.// St. Louis, MO: Mosby; 2004: 876. [3] D2L. Brain, Brainstem, & Cerebellum. Available at: []. Assessed on June 1, 2011. 1. Steven AL, Theodore LP. Textbook of Radiation Oncology, 2nd ed. Saunders; 2004. 2. Eric KH, Mack R. Handbook of Evidence-Based Radiation Oncology; 2nd ed. Springer; 2010. 3. Anne Marie V, Byron GD, Sharon KC, Nancy HW. Portal Design in Radiation Therapy; 2nd ed. R.L Bryan Company; 2006.
 * Radiation Side Effects: || ** Acute effects: **
 * Late effects: **
 * Prognosis: || The median survival for patients with Anaplastic Astrocytoma is 36 months, and the 3 year survival rate is approximately 50 %. ||
 * Treatments: || ** Surgery: **
 * Radiation therapy: **
 * Three Dimensional Conformal Radiation Therapy (3DCRT): **
 * Intensity Modulated Radiation Therapy (IMRT): **
 * Stereotactic Radiosurgery (SRS) and Hypofractionated Stereotactic Radiosurgery (SRT) **
 * TD5/5: || [[image:Image_5_Table.jpg width="520" height="174"]] ||