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  • Question: My partner was diagnosed with an Anaplastic Astrocytoma two months ago. It is located above the thalamus and was biopsied only. He is completing six weeks of radiotherapy with 8 treatments to go. We have seen two neuro-oncologists who have differning opinions on chemotherapy. One of the doctors has advised treatment with BCNU commencing one month after radiotherapy is completed. This would be done every 8 weeks for a year. The other doctor has advised not using any chemotherapy until there is a recurrence. Can you please advise if there are any trial results on timing of chemotherapy and which chemotherapy regimen is most beneficial in the treatment of AA. Also, are there any other trial results that look promising? We are in Melbourne, Australia so have limited access to trials but are willing to fly to the States if need be.
  • Answer:06/24/2002
    Chemotherapy after radiation is a good idea and will improve the results. There are several good protocols on the virtualtrials website.

    The survival expectation for someone with an AA3 depends on the tumor location, amount of tumor which can be resected, the patient's age and functional state and other coexistant medical conditions. With that said, most studies indicate a five-year disease free survival after diagnosis of between 40-70% of all patients. Most studies suggest that radiation AND PCV are an effective combination for AA3 and changes in the recipe yield unpredictable results. The drugs have different mechanisms of action on the enzymes that repair DNA damage. They may even work together additively, from a theoretical standpoint. Single drug therapy with BCNU is not used much in the USA for AA3. The best accepted therapy is for as complete removal as possible, radiation therapy, followed by chemotherapy, usually a derivative of Procarbazine, CCNU and vincristine, though Temodar is also widely used. With this combination, a five-year disease free probability is 40+%, based on numerous studies. Treated with chemotherapy and radiation the outlook for long survival can be good. Forty five to 70% of people with this tumor are alive and well five years after diagnosis and many go on to long productive lives. Remember, the statistics are only applicable to groups and not individuals. Therefore the statistics are of little use to the individual once you have chosen the treatment pathway.
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