From the Guidelines
Diffuse astrocytoma can present with initial symptoms of executive dysfunction, depression, and intensification of sleep issues, as these symptoms are related to the tumor's location and its impact on surrounding brain tissue. The presentation of diffuse astrocytoma is highly variable and depends on the tumor's location, size, and grade, as well as the individual patient's overall health and brain function 1. Diagnosis involves a combination of clinical evaluation, neuroimaging with MRI, and histopathological examination of tumor tissue obtained through surgical biopsy or resection.
Some key points to consider in the diagnosis and treatment of diffuse astrocytoma include:
- The importance of IDH mutation status and other molecular markers in guiding prognosis and treatment decisions 1
- The role of maximal safe surgical resection, radiation therapy, and chemotherapy with temozolomide in the management of diffuse astrocytoma 1
- The need for individualized treatment decisions based on patient age, tumor location, molecular profile, extent of resection, and performance status, with multidisciplinary tumor board input recommended 1
- The importance of regular follow-up with serial MRIs to monitor for tumor progression and adjust treatment as needed 1
In terms of treatment options, radiation therapy (typically 50-54 Gy in 1.8-2 Gy fractions) may be recommended immediately after surgery or at progression, and chemotherapy with temozolomide (75-150 mg/m² daily for 5 days every 28 days) is often used concurrently with or after radiation, particularly for IDH-mutant tumors 1. Overall, the management of diffuse astrocytoma requires a comprehensive and multidisciplinary approach, taking into account the latest evidence and guidelines in the field 1.
From the Research
Presentation of Diffuse Astrocytoma
- Diffuse astrocytomas (DAs) are diffusely infiltrating World Health Organization (WHO) grade II neoplasms that represent less than 10% of all gliomas 2
- The initial symptoms of diffuse astrocytoma can vary, but they often include tumor-associated epilepsy, and in some cases, executive dysfunction, depression, and sleep issues may also be present
- However, there is limited information available on the specific presentation of diffuse astrocytoma with initial symptoms of executive dysfunction, depression, and intensification of sleep issues
Diagnosis of Diffuse Astrocytoma
- The diagnosis of diffuse astrocytoma is based on histological and molecular features, including IDH1/IDH2 sequencing and neuroimaging review 3
- DNA methylation status and copy number profiles can also be assessed to classify the tumor and predict its behavior
- It is essential to note that the existence of diffuse astrocytoma, IDH-wildtype, is unclear, and most IDH-wildtype tumors showing histopathological and radiological features of low-grade diffuse astrocytoma exhibit molecular and clinical features of high-grade glioma 3
Treatment Options for Diffuse Astrocytoma
- The goals of treatment for diffuse astrocytoma are to prolong survival, prevent progression and malignant transformation, and optimally manage symptoms, primarily tumor-associated epilepsy 2
- Available data suggest that the course of this disease is only minimally impacted by adjuvant therapies, and there does not seem to be much difference in terms of outcome whether patients are treated in the adjuvant setting with irradiation or chemotherapy 2
- Selective serotonin reuptake inhibitors (SSRIs) may have antiepileptic properties and could be considered as a potential treatment option for managing epilepsy associated with diffuse astrocytoma 4, 5