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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016



Pilocytic astrocytomas | Diffuse astrocytomas

Part 3 is a guide to the treatment options

for adults with astrocytoma. Options are

based on the cancer grade. Also, you

may have an option of joining a clinical

trial. This information is taken from the

treatment guidelines written by NCCN

experts for doctors treating gliomas. Your

doctors may suggest other treatments

than those listed in Part 3 based on your

health and personal wishes.

Pilocytic astrocytomas

Pilocytic astrocytomas are the most common type

of grade I astrocytomas. These tumors have well-

defined edges. They also rarely become a higher

grade astrocytoma. Therefore, pilocytic astrocytomas

are often cured with surgery. In this case, no further

treatment is needed. If the tumor wasn’t fully

removed, you may receive radiation therapy.

Diffuse astrocytomas

The best treatment for grade II diffuse astrocytomas

still needs to be confirmed. A team of health experts

can discuss what treatment is best for you. Your team

may consist of a neurosurgeon, radiation oncologist,

medical neuro-oncologist, and other experts. At this

time, NCCN experts believe that surgery is still very

important for diagnosis and treatment. The first goal

of surgery is to remove enough tissue for diagnosis

and cancer grading.

Guide 3

lists treatment options for diffuse

astrocytomas. Your surgeon will assess how much

of the tumor he or she can remove. The amount that

will be removed depends on where the tumor is, your

age and health, and other factors. Your surgeon does

not want you to be less able to think, speak, and

move afterward.

Maximal safe resection

A maximal safe resection is a treatment plan to

remove all or most of the tumor as is safe. Hopefully,

the whole tumor will be removed. Removal of

the whole tumor is called a gross total resection.

However, your surgeon may decide during surgery

that the whole tumor can’t be removed. Removing

only part of the tumor is called a subtotal resection.

Other surgeries

There are other options if it is known before surgery

that a maximal safe resection can’t be done. These

options are a subtotal resection, open biopsy, and

stereotactic biopsy. The removed tissue will be tested

to confirm diagnosis and cancer grade.


Surgery is advised in general. However, for some

people, observation may be an option. Observation

consists of one or more cancer tests repeated over a

period of time. Treatment to remove the cancer or to

relieve symptoms may be started if the status of the

cancer changes.

Tests after surgery

The removed tissue will be sent to a pathologist for

testing. The pathologist will confirm if there’s cancer,

and if so, the cancer grade. If the cancer is partly an

oligodendroglioma, your doctor may want the cancer

cells to be tested for 1p19q deletions. This test may

help your doctor predict the outlook (prognosis) of

the cancer.

You should receive a brain MRI if you had a gross

total or subtotal resection. MRI should be done within

24 to 72 hours after surgery. Images will be made

with and without contrast. This test can confirm how

much of the cancer was removed. If you can’t have

MRI, you may receive a CT scan with and without