Types of treatment for Astrocytoma

Executive Summary

The different types of treatment methods for astrocytoma are explained in detail. Clinical trials have been considered the novel therapeutic method for treating astrocytoma in young people. The gold standard of care is another necessary treatment for astrocytoma. The novel drugs, new combinations of existing Astrocytoma treatments, and further doses of existing treatments are considered in clinical trials. Some of the most common types of treatment include surgery, biopsy, medication-based therapy (chemotherapy, targeted therapy, immunotherapy), radiation therapy, and palliative care. Palliative care is also used for treating astrocytoma patients who are going through emotional, social, and biological distress. The recurrence of astrocytoma needs to be checked even after the treatment. Chemotherapy and radiation therapy is recommended in case of high-grade recurring astrocytoma. If the treatment of astrocytoma fails, hospice care is provided to the patients with a life expectancy of fewer than six months, the highest possible quality of life. 

How Astrocytoma is Treated?

Tumors in children are infrequent in general. It makes it difficult for doctors to arrange therapies unless they know what has worked well in other youngsters. More than 60% of youngsters are treated as part of a clinical trial for this reason. A clinical trial is a research study that evaluates a novel therapeutic method. The “gold standard of care” refers to the most effective therapies available. Clinical trials might evaluate novel drugs, new combinations of existing Astrocytoma treatments, or further doses of existing treatments ​1​. All youngsters taking part in clinical studies have their health and safety adequately monitored ​2​.

Children with a CNS tumor should be treated at a specialized cancer facility to take advantage of these novel treatments ​3,4​. These Centres doctors have expertise in treating kids and access the most up-to-date research. A pediatric oncologist is a specialist who specializes in treating children with tumors. A neuro-oncologist may be engaged in the treatment of astrocytoma. It is a doctor who specializes in tumors of the central nervous system. If a pediatric cancer Centre isn’t available, general cancer Centres may have pediatric and neurological specialists who can help with your child’s treatment.

Overview of the treatments

In many circumstances, a team of doctors provides Astrocytoma treatments to a child and their families. A multidisciplinary team is what this is referred to as. Child life experts, nutritionists, physical and occupational therapists, social workers, and counsellors are all standard supplemental support services offered to children and their families at pediatric cancer hospitals. There may also be special activities and programmes available to assist your child and family cope.

The following are descriptions of the most prevalent types of astrocytoma treatments and additional treatments such as targeted therapy and immunotherapy offered through clinical trials ​5​. Your child’s treatment plan includes treatment for symptoms and side effects, an essential element of cancer care,

 type and grade of the tumour, potential adverse effects, the family’s choices, and the child’s overall health influencing Astrocytoma treatment options and recommendations.

Take the time to learn about your child’s Astrocytoma treatment options, and don’t be afraid to ask questions if something isn’t apparent. Discuss the aims of each treatment with your child’s doctor and what to expect during the treatment. “Shared decision making” is the term for these types of discussions. When you and your doctors work together to determine therapies appropriate for your child’s needs, this is known as shared decision making. Because there are several treatment choices for astrocytoma, shared decision making is especially crucial.

Surgery

During an operation, the tumor and some surrounding healthy tissue are removed. It is the most common astrocytoma treatment. A neurosurgeon removes as much of the tumor as feasible during surgery. A tumor might sometimes be inoperable, which means it can’t be reached by surgery due to its position. Even if a tumor is inoperable, a surgical biopsy can typically be performed to determine the kind and grade of the tumor.

In case if we cannot entirely remove a low-grade tumor, the doctor would typically monitor the tumor for symptoms of growth before proposing another Astrocytoma treatment option. Radiation therapy or chemotherapy are frequently utilized when a tumor produces symptoms and cannot be entirely removed with surgery. Whether or not remove the entire tumor during surgery, a kid with a high-grade tumor often needs additional treatment. Before surgery, discuss the potential adverse effects of the recommended surgery with your child’s health care team and how to manage them.

Radiation Therapy

Radiation therapy is a type of treatment that uses high-energy x-rays or other particles to eliminate tumor cells is known as radiation therapy. A radiation oncologist is a doctor who specializes in treating tumors with radiation treatment.

External-beam radiation therapy, in which radiation is delivered from a machine outside the body, is the most prevalent radiation treatment method. Internal radiation therapy, also known as brachytherapy, is a type of radiation therapy that uses implants to deliver radiation. A radiation therapy regimen, often known as a schedule, comprises a defined number of treatments administered over time.

Fatigue, moderate skin responses, unsettled stomach, and loose bowel motions are all possible side effects of radiation therapy. The majority of short-term adverse effects fade away as Astrocytoma treatments are completed.

Radiation therapy can sometimes interfere with a child’s brain’s long-term growth and development. It suggests that the doctor may opt for a different approach to treating the tumour. The doctor may initially use chemotherapy (see below) to shrink the tumour to avoid or reduce the need for radiation therapy.

Medication-based Astrocytoma treatments

The use of drugs to kill tumor cells is known as systemic treatment. This sort of drug is injected into the bloodstream to reach tumor cells all over the body. A pediatric hematologist-oncologist, a clinician specializing in medication to treat cancers in children, usually prescribes systemic therapy.

An intravenous (IV) tube inserted into a vein with a needle or a pill or capsule that is eaten is two common ways to administer systemic medicines (orally).

The following are examples of systemic therapy for astrocytoma:

  • Chemotherapy
  • Targeted therapy 
  • Immunotherapy

Each of these sorts of therapy is covered in further depth further below. Systemic treatment may give one form at a time or a variety of systemic treatments simultaneously. They can use them with surgery and radiation therapy.

The drugs used to treat astrocytoma are being tested all the time. The best approach to understanding the medications provided for your kid, their purpose, and any potential adverse effects or combinations with other medications is to speak with their doctor. It’s also crucial to inform your doctor if your child takes any additional medications or supplements, whether prescription or over-the-counter. Anti-tumor treatments can interact with herbs, vitamins, and other pharmaceuticals.

Chemotherapy

Chemotherapy uses medications to kill tumor cells by preventing them from growing, dividing, and producing new ones.

A chemotherapy regimen, often known as a schedule, consists of a defined number of cycles administered over a set time. A patient may be administered a single medicine at a time or a mixture of drugs simultaneously. Astrocytoma is treated with a mixture of two or three medicines.

Chemotherapy may be used to postpone or avoid radiation therapy in young children with low-grade tumors like JPA due to the risk of adverse effects. Chemotherapy may be more effective when paired with surgery and radiation therapy for a high-grade malignancy.

Chemotherapy side effects vary by individual and dose, but they can include fatigue, infection risk, nausea and vomiting, hair loss, loss of appetite, and diarrhoea. These side effects usually subside once the Astrocytoma treatment is completed. Please consult your child’s doctor about what to expect based on their medications.

Targeted Therapy 

Targeted therapy is a type of treatment that focuses on the genes, proteins, or tissue environment that contribute to the tumor’s growth and survival. This treatment inhibits tumor cell growth and spreads while limiting damage to healthy cells.

The targets of all cancers are not the same. Your child’s doctor may undertake tests to determine the genes, proteins, and other variables in the tumor to find the most effective treatment. It allows doctors better to match each child with the most appropriate treatment when possible. Furthermore, research studies continue to uncover new information about specific molecular targets and new treatments aimed at them.

Larotrectinib (Vitrakvi) is a sort of targeted therapy that targets a specific genetic mutation called an NTRK fusion rather than a particular type of tumor. It is also known as tumor-agnostic therapy. A variety of cancers, including astrocytoma, have this type of genetic alteration. Larotrectinib is licensed to treat astrocytoma that has progressed despite prior treatments and is metastatic or cannot be removed surgically.

To discover more about treatment possibilities within a research trial, speak with your child’s doctor. Also, inquire about the medication’s potential adverse effects and how they might handle them.

Immunotherapy

Immunotherapy, also known as biologic therapy, aims to increase the body’s natural defences to combat cancer. It improves, targets, or restores immune system function by using materials created by the body or laboratory.

Clinical trials for immunotherapy for astrocytoma are presently underway. To discover more about treatment possibilities within a research trial, speak with your child’s doctor.

Various forms of immunotherapy can have a variety of adverse effects. Skin rashes, flu-like symptoms, diarrhoea, and weight fluctuations are common adverse effects. Consult your kid’s doctor about any potential side effects from the immunotherapy your child is receiving.

Effects on the physical, emotional, and social levels

Physical symptoms and side effects and emotional, social, and economic impacts are all caused by a CNS tumor and its treatment. Palliative care, also known as supportive care, is the process of coping with all of these side effects. It’s a crucial aspect of your child’s care.

Supportive care aims to improve your child’s quality of life during treatment by treating symptoms and assisting patients and their families with non-medical needs. This form of therapy is available to everybody, regardless of age, tumor type, or stage. And it’s most effective when started soon after a CNS tumor is discovered. People who receive palliative care in addition to tumor treatment frequently have fewer symptoms, a higher quality of life, and are more satisfied with their treatment.

Medication, nutritional adjustments, relaxation techniques, emotional and spiritual support, and other therapies are all examples of supportive care. Your kid may also get palliative treatments like chemotherapy, surgery, or radiation therapy, comparable to those used to remove the tumor.

Before starting treatment, discuss the aims of each treatment in the treatment plan with your child’s doctor. It would help to examine the treatment plan’s potential adverse effects and palliative care options.

During therapy, your child’s health care provider may ask you to detail each concern and answer questions regarding your child’s symptoms and side effects. If your child has a problem, make sure to alert the health care personnel. It enables the medical team to treat any symptoms or adverse effects as soon as feasible. It may also aid in preventing more significant issues in the future.

The chances of recurrence and remission

When tumor cells cannot be discovered in the body, and there are no symptoms, the patient is in remission. It is also known as NED, or “no evidence of disease.” Remission may be temporary or permanent. Many people are concerned that the tumor will return due to this uncertainty. While many remissions are durable, it’s vital to discuss the risk of the disease returning with your child’s doctor. Knowing your child’s recurrence risk and treatment options will help you feel better prepared if the tumor returns. 

Find out how to deal with the worry of recurrence

A recurrent tumor occurs when the tumor returns after the initial Astrocytoma treatment. It may reoccur in the exact location (called a local recurrence), in a nearby area (called a regional recurrence), or in a different place (called a regional recurrence) (distant recurrence). When astrocytoma recurs, it usually does so around the site where the tumor first appeared.

When this happens, a new testing cycle will begin to understand the recurrence as much as possible. You and your child’s doctor will discuss treatment choices following the testing. The Astrocytoma treatments outlined above, including surgery, radiation therapy, and systemic therapies involving medication, are frequently included in treatment plans. Still, they may be performed differently or at a different pace. Your child’s doctor may refer you to clinical studies looking for novel approaches to treat recurrent tumors. Palliative care will be vital for alleviating symptoms and side effects regardless of the treatment option.

Three factors influence recurrent astrocytoma treatment:

  • The tumor’s grade
  • The location of the recurrence of the tumor
  • The type of cancer therapy your child underwent when they were younger.

The doctor may do surgery to remove as much of the tumor as feasible if it is a low-grade recurrent astrocytoma. Children who have not previously received radiation therapy or chemotherapy for a recurring tumor may get one or both of these therapies.

The doctor may recommend different chemotherapy or radiation therapy if the tumor is a high-grade recurring astrocytoma. In rare cases, chemotherapy and stem cell/bone marrow transplantation may be recommended.

A recurring tumor can elicit feelings of disbelief or anxiety. You and your family are advised to discuss these sentiments with your health care team and inquire about support programmes to help you manage.

If the Astrocytoma treatment fails,

Although many children with CNS tumors respond well to Astrocytoma treatment, this is not always the case. An advanced or terminal tumor cannot be treated or controlled in a child. It is a traumatic diagnosis, and a progressed tumor may be tough to address. It is, however, critical to have open and honest discussions with your child’s health care team to communicate your family’s thoughts, desires, and concerns. The healthcare staff has specialized skills, expertise, and experience to assist patients and their families.

Hospice care is aimed to give people with a life expectancy of fewer than six months the highest possible quality of life. Parents and guardians are urged to discuss hospice choices with the health care team, including home hospice, a particular hospice centre, or other health care sites.

For many families, remaining at home with nursing care and appropriate equipment is a viable alternative. Some kids may be happier if they can go to school part-time or participate in other activities and maintain social relationships. The health care team for the kid can assist parents or guardians in determining an acceptable level of activity.

As part of end-of-life care, it’s critical to ensure that a child is physically comfortable and pain-free. Learn more about advanced care planning and caring for a terminally sick child.

The death of a child is a tragic event, and families may require assistance in coping with the loss. Professional personnel and support groups are frequently available at pediatric cancer hospitals to assist with mourning. Find out more about grieving a child’s death.

References

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