If an operation on the astrocytoma is planned, a cortisone preparation (dexamethasone) must be administered beforehand to reduce the swelling of the tumour. It is also possible to administer the cortisone during radiotherapy, as radiotherapy can initially increase the edema. Accompanying symptoms of an astrocytoma or glioblastoma can be epileptic seizures (convulsions). In these cases, further seizures must be prevented with appropriate antiepileptic drugs to protect the patient.
Surgery is an effective treatment for astrocytoma or glioblastoma and it also offers the possibility to examine the removed tumor tissue pathologically under the microscope. In this way it can be determined whether the tumour could be completely removed and to which WHO grade the present tumour falls. The so-called pilocytic astrocytoma (WHO grade I) can usually be completely removed by surgery.
This is also usually successful with grade II astrocytomas, whereas grade III and grade IV tumours (e.g. glioblastomas) have grown into the neighbouring tissue in such a way that complete removal is impossible in most cases. In this case, surgery is only used to reduce the size of the tumour in order to improve the pressure on the brain and thus the acute symptoms of the patient. Subsequently, radiation treatment or chemotherapy is used to further treat the tumour.
Radiotherapy and chemotherapy
If the WHO grade of the astrocytoma is low, radiotherapy is performed after the operation if the post-operative CT control image shows that there are still tumor remnants in the brain after the operation and these may continue to grow. Radiation therapy is also recommended if the tumour can only be partially removed from the outset. Patients with a grade III or IV astrocytoma also receive concomitant radiotherapy and chemotherapy regardless of the tumor mass removed during surgery.
For grade II to IV astrocytomas, radiotherapy is often supplemented by chemotherapy. However, it is important that the patient’s blood count is normal and that there are no disturbances/diseases of the liver, kidneys, respiratory tract or cardiovascular system.