Anaplastic astrocytoma (grade 3 astrocytoma): treatment and outlook

Astrocytomas develop from astrocytes, the star-shaped glial cells that support nerve cells in the brain. Cancer Research UK explains that astrocytomas are graded according to how quickly they are likely to grow, with IDH mutated astrocytomas falling into grades 2, 3 and 4.

Anaplastic astrocytoma is the traditional name for a grade 3 astrocytoma. The Brain Tumour Charity describes grade 3 tumours as fast growing and more aggressive than grades 1 and 2, and a type of high grade glioma. Under the current WHO classification used by Cancer Research UK, they are described as astrocytoma, IDH mutant.

Doctors test the tumour cells for changes in genes such as IDH, because the results help determine the type of glioma and guide treatment.

The Brain Tumour Charity says grade 3 astrocytomas are more common in adults between 30 and 70 and in males. It says the cause of most brain tumours is not entirely understood and stresses there is nothing a person could have done or avoided that would have caused a brain tumour. Some genetic conditions, such as neurofibromatosis type 1, make brain tumours more likely.

Symptoms depend on where the tumour is. Cancer Research UK lists headaches, seizures, weakness or numbness in the arms and legs, eyesight problems such as blurred vision, changes in personality and problems with balance and movement. The Brain Tumour Charity adds difficulty speaking and difficulty thinking or remembering, and notes symptoms can be very different between people because astrocytes are found throughout the brain.

Any new seizure, persistent headache with other neurological changes or progressive weakness needs prompt medical assessment through a GP, NHS 111 or emergency services depending on severity.

Cancer Research UK says tests to diagnose an astrocytoma may include an MRI or CT scan, a neurological examination and a biopsy, with the size and location of the tumour helping to plan treatment. The grade depends on how the cells look and on genes and proteins in the tumour, and the Brain Tumour Charity says biomarker testing for gene mutations is now essential for diagnosis and for evaluating which treatments will be used.

Cancer Research UK says surgery is usually the first treatment for a grade 3 astrocytoma, where possible. After surgery you usually have radiotherapy, and usually also chemotherapy with a drug called temozolomide.

The Brain Tumour Charity says the first treatment is generally neurosurgery to remove as much of the tumour as possible. It says that if you are relatively fit a long course of radiotherapy over several weeks may be suggested, and if not a shorter course may be more suitable. Where chemotherapy is suggested, drugs such as carmustine may be placed in the brain in a polymer wafer during surgery to target cells that could not be removed, and temozolomide may be recommended.

The Brain Tumour Charity says grade 3 astrocytomas often come back following treatment in a more advanced form. Cancer Research UK says treatment can control the tumour for some time but it can start to grow again, and that treatment then depends on what you had before and when, your symptoms and where the tumour is.

Options may include more surgery, more radiotherapy or more chemotherapy, such as temozolomide, the PCV combination (procarbazine, lomustine and vincristine) or lomustine on its own. Your doctor will talk through what is suitable, and your healthcare team will care for and support you.

Cancer Research UK says you have regular appointments after treatment finishes, with an examination and questions about symptoms and side effects, and MRI scans on some visits, for example every 3 to 6 months for two years then every 6 months or every year depending on your situation.

It adds that a brain tumour can affect your ability to drive and you may not be allowed to drive for some time after diagnosis or treatment. It acknowledges that coping with a high grade tumour can be especially difficult and that being well informed and speaking to a specialist nurse or the charities can help.

The Brain Tumour Charity says it is impossible to answer questions about how long someone can live with an astrocytoma for certain, because it depends on tumour grade, size and location, general health, individual body chemistry and response to treatment. It publishes a prognosis page with rough averages.

Because outlook varies so much between individuals, the best source of information about your own situation is your neuro-oncology team, who know your tumour's grade, gene findings and response to treatment.

On the NHS, treatment is planned by a specialist multidisciplinary team, and nurse specialists are available for questions. Cancer Research UK also cites NICE guidance on brain tumours and vorasidenib for some astrocytomas.

A private opinion or a second opinion may be sought, and The Brain Tumour Charity publishes information about getting a second opinion. Whichever route you take, make sure pathology, genetic results and scans are shared between teams.