Malignant astrocytomas

Introduction
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By Edward J Dropcho MD

Malignant astrocytoma is also known as or subsumes High-grade astrocytoma, Anaplastic astrocytoma, Giant cell astrocytoma, and Glioblastoma multiforme. -ed

The term “malignant astrocytoma” includes glioblastoma and anaplastic astrocytoma. Glioblastoma is the most common glioma in adults, with approximately 10,000 new cases diagnosed yearly in the United States. Unfortunately glioblastoma is also the most lethal primary brain tumor in adults. Anaplastic astrocytoma is less common than glioblastoma and carries a somewhat better prognosis, but it still leads almost invariably to a fatal outcome. There have been tremendous advances in the understanding of the cell biology and molecular genetics of malignant astrocytomas in the past 20 years. This new knowledge is slowly but steadily leading to new therapeutic strategies. Dr. Dropcho of the Indiana University Department of Neurology reviews the biology, diagnosis, work-up, prognosis, current patient management, and future therapies for malignant astrocytoma.

Key points

  • Glioblastoma is the most common and most malignant primary brain tumor in adults. Anaplastic astrocytoma is less common and, on average, occurs in younger persons than glioblastoma.
  • Molecular genetic abnormalities in malignant astrocytomas are complex and heterogeneous among individuals, although most tumors show dysfunction of several key molecular pathways.
  • The major prognostic factors for survival among patients with malignant astrocytoma are tumor grade, patient age, and performance status at diagnosis.
  • Current standard therapy for glioblastoma is aggressive surgical resection (if safe and feasible), followed by fractionated radiation therapy and temozolomide chemotherapy.
  • There are numerous clinical trials of innovative therapies for patients with malignant astrocytoma, including investigational radiation therapy, other chemotherapy agents, and molecularly targeted agents.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors