Current Management of High-grade Astrocytic Neoplasms— Small but Tangible Progress

A report by Renato V La Rocca, MD, Oncologist and Director, Kentuckiana Cancer Institute, Kentucky

The last five years have seen an evolution in the management of high-grade astrocytic tumors comparable in scope yet greater in magnitude to that of the prior 40 years. This is thanks to the convergence of three factors: the introduction of an oral agent with antitumor activity beyond the blood–brain barrier and modest systemic toxicity (temozolomide); the demonstration through a well-conducted randomized trial of the superiority of multimodality therapy; and the fact that we now stand on the threshold of additional progress through key advances in translational biology, which, in many cancers, is providing new targets for therapeutic intervention.

Astrocytic tumors have long been the bane of neurosurgeons, radiation therapists, and neuro-oncologists. Although they account for only 2.3% of all cancer-related deaths in the US,1 little if any substantial progress in brain imaging and treatment had been made until the first years of this millennium. Characteristics of high-grade glial tumors compared with other cancers are its unique location, robust invasive and angiogenic capabilities without a significant propensity to metastasize outside of the central nervous system (CNS), and the profound histological and molecular heterogeneity within tumor specimens. [Read more…]