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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.
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