Course of treatment for anaplastic astrocytoma grade 3

Craniotomy in May 05, significant, but not gross total resection. Left frontoparietal area. I did 4 cycles of Temodar up front(it was working) followed by low dose Temodar concurrent with radiation. My MRI in November showed tumor was stable yet the recommended course of treatment was 2 cycles of CCNU (which I reluctantly did one of),followed by CPT-11 and Avastin. Then PROBABLY Tamoxifen or Celebrex. I got a second and compared Nov. MRI with one in Jan., stable. The neuro-oncologist at my second place of treatment questioned the RX of CCNU, said that should only be if something wasn't going right and the fact that I am 35, why did I want to expose myself to all the future toxicities with these chemos? I believe  there has not been any enhancement since September after the Temodar. Although one area of concern led to a PET scan which was cold. My second place of treatment seemed right to me which was stop chemo now and wait and see with MRI's every 2-3 months. If there is a recurrence I would be looking at clinical trials. I requested another PET scan locally for peace of mind. Is there a right or wrong? What is your opinion?

Real quick- if the majority of my tumor was grade 2 is the grade 3 mixed in with that or is it a mass within the tumor that could have been removed with surgery or eradicated with radiation?

Thanks

[CCF-Neuro-M.D.-PW]

I cannot give you a formal clinical opinion as this forum is for educational purposes only so my advice is limited.

Grade 3 astrocytomas without total resection are generally not curable and chemotherapy serves to prolong survival - so the tumor cells are still present although temporarily kept at bay by the chemotherapy - how much they are kept at bay is debatable as the MRI does not have enough resultion to detect small amounts of spread or diffuse microscopic disease, although at least larger amount of growth can be identified. There is no world or US standardized protcol on how aggressive one should be with chemotherapy - but because of this fact, some places are more aggressive than others.

Even if the majority of the tumor is grade 2, any part that is grade 3 means that as a whole it is classified grade 3. It is impossible to sample the entire tumor under the microscope to completely exclude that all parts are grade 2 or 3. As I mention above there may also be parts not visible by MRI that may be grade 2 or 3. Hence it is safer to call the whole tumor grade 3.

I hope your further treatments are successful. Good luck

[rm0407]

A related discussion, treatment of grade 3 anaplastic astrocytoma with avastin was started.