Standard treatment for low grade astrocytomas?

[C-H__0]

  Hi, and thanks for taking my question...
  I am a forty yr old female and was recently diagnosed with a low grade Astrocytoma in my left temporal lobe. My NS told me it was operable but it would not be likely to get it all as it was infiltrative and that some doctors recommend radiation post surgery and some recommend *against* it. I will soon be seeking a second opinion and another surgeon (I haven't felt comfortable with my current NS and had decided to seek another after the biopsy). I am interested in what the Cleveland Clinic considers standard therapy for low grade Astrocytomas. I feel very uncomfortable taking the 'wait and see' approach, it feels like lighting a fuse and waiting to see how big the bang is going to be.
  Thanks for any information you can give me.
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Dear C H,
There are two schools of thought regarding how a low grade astrocytoma may be treated.  Many patients with such tumors in the temporal lobe will have a history of seizures that can be controlled with oral anticonvulsants.  In that absence of intractable seizures or mass effect in the brain, it is reasonable and accepted to follow such patients clinically.  The risk in any low grade astrocytoma is that it can upgrade into a more aggressive tumor.  Some argue that, based on the infiltrative nature of the tumor, surgery does not alter that progression and that simply following the patient is reasonable.
The other mode of thought is to resect as much of the tumor as possible early without causing a deficit.  The idea is to remove as much of the abnormal tissue as possible and provide a better long-term survival.  The problem is that some of the patients with a gross total resection progress to having a more aggressive tumor in spite of previous surgery.  Also, don't forget that there are risks to any surgery in the brain.
At The Cleveland Clinic we reserve radiation therapy for when a patient has an upgrade of the tumor into a more aggressive form.  The reason is that there are side-effects of radiation and the brain can tolerate only so much.  Therefore it is reserved for those patients who would benefit most from the radiation.
Speak to your surgeon about these issues.  A second opinion is certainly reasonable in this situation and is probably wise.  There is no one answer for the minimally symptomatic low grade astrocytoma.  Get the second opinion and think it over.
Good luck.