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Paper Abstract

Long-term quality of life in cerebellar astrocytoma is more important than the initial control of the tumor - here’s why?

The standard of care therapeutics has resulted in incredible success in the achievement of initial tumor control in a majority of cerebellar astrocytoma patients. This approach has shifted the focus of treatment to maintain a good quality of life after complete tumor resection. This blog reviews the shift in the goal of cerebellar astrocytoma treatment looks into the long-term problems faced by the patients and reviews some of the innovative ways to improve the quality of life of the patients.

What is cerebellar astrocytoma?

Cerebellar astrocytoma is a brain tumor found in the lower part of the brain, called the cerebellum. Among the brain tumors, it belongs to the “glioma” category which are tumors arising from helper cells in the brain. And specifically, it originates from a type of brain cells, called astrocytes, which nourish the neurons and help in their metabolism. Depending upon the grade, it may belong to one of four subtypes; pilocytic astrocytoma, low-grade fibrillary astrocytoma/diffuse astrocytoma, anaplastic astrocytoma, or glioblastoma multiforme. The most common of these subtypes is pilocytic astrocytoma which mostly affects children. It does not grow aggressively and thus is a low-grade tumor. Furthermore, its borders are well-defined which makes it easy to be diagnosed and removed.

Quality of life should be a priority in cerebellar astrocytoma management!

The standard of care treatment for pilocytic astrocytoma is gross total resection of the tumor. For this purpose, a craniotomy (removal of a part of skull bone to expose the brain) is performed and the observable tumor mass is removed. Gross total resection, when achieved results in over 90% progression-free survival of over 10 years [1]. But in some cases, it is not possible to remove the whole tumor. For these patients, additional therapies, such as chemotherapy and innovative forms of radiation therapy, are recommended that kill the remaining cells.

cerebellar astrocytoma.jpg

The long-term effects of cerebellar astrocytoma are debilitating!

The above-mentioned approach resolves the initial symptoms of headache, lethargy, vomiting, and clumsiness, caused by the tumor itself or the increased pressure due to the buildup of fluid in the brain. But the permanent damage caused by the tumor to the brain, brain surgery, or radiation therapy leads to long-term complications such as [2]:

  • Cognitive deficits such as impairment of executive functions, visuospatial cognition, and self-regulation

  • Swallowing difficulties

  • Poor balance and clumsiness

  • Spasticity

  • Hormonal imbalance

  • Speech impairments and deteriorated language skills

 

These neurological deficits impair a person’s daily activity and negatively affect their emotional, functional, and social life. Therefore, the goal of low-grade gliomas, such as pilocytic astrocytoma, has changed from only resolving the initial symptoms to ensuring that the patients can live a good quality life after the treatment.

What can be done to prevent and manage these complications?

There are two broad strategies when it comes to achieving a good quality of life in pilocytic astrocytomas patients:

  1. Preventing avoidable brain damage during initial treatment: As mentioned, an aggressive resection of the tumor particularly the one close to vital parts of the brain may cause neurological complications corresponding to the areas damaged. So, the surgery is performed very carefully with the help of advanced guidance aids to prevent the accidental removal of healthy tissue. Moreover, the radiation also damages the normal tissue of the brain. In this regard, advanced radiation therapy techniques, such as stereotactic radiosurgery, can be used to precisely deliver high-dose radiation to the tumor while sparing adjacent normal healthy tissues.

  2. Managing the effects of unavoidable brain damage: Despite all efforts to preserve the nearby healthy brain tissues, destruction of some parts of the brain is inevitable due to the growth of the tumor or its resection. The complications arising from this can be managed through various non-pharmacological methods such as physical exercise, psychoeducation, and neurorehabilitation programs. Firstly, physical exercise improves coordination that has deteriorated due to damage to the cerebellum [3]. Secondly, the effects of cognitive deficits can be diminished by changing the environment in such a way that the patients have to rely less on the affected cognitive abilities and technological aids are used to make up for some of the cognitive deficits [4]. Moreover, neurorehabilitation programs, currently tailored towards survivors of traumatic brain injury, may also be useful in improving the quality of life of cerebellar astrocytoma survivors.

In a nutshell

The high rate of success in the initial management of cerebellar astrocytoma but the devastating long-term effects of this treatment have elevated the importance of maintaining a good quality of life after the removal of the tumor. Therefore, the management of cerebellar astrocytoma today is focusing on minimally invasive techniques, such as stereotactic radiosurgery, to safely remove the tumor without damaging the vital parts of the brain and interventions, such as physical exercise and neurorehabilitation, to improve the quality of life.

References

  1. C. M. Bonfield and P. Steinbok, “Pediatric cerebellar astrocytoma: a review,” Childs Nerv Syst, vol. 31, no. 10, pp. 1677–1685, Oct. 2015, DOI: 10.1007/s00381-015-2719-1.

  2. T. Pletschko et al., “Cerebellar pilocytic astrocytoma in childhood: Investigating the long-term impact of surgery on cognitive performance and functional outcome,” Developmental Neurorehabilitation, vol. 21, no. 6, pp. 415–422, Aug. 2018, DOI: 10.1080/17518423.2017.1370502.

  3. G. T. Levin, K. M. Greenwood, F. Singh, D. Tsoi, and R. U. Newton, “Exercise Improves Physical Function and Mental Health of Brain Cancer Survivors: Two Exploratory Case Studies,” Integr Cancer Ther, vol. 15, no. 2, pp. 190–196, Jun. 2016, DOI: 10.1177/1534735415600068.

  4. F. W. Boele, M. Klein, J. C. Reijneveld, I. M. Verdonck-de Leeuw, and J. J. Heimans, “Symptom management and quality of life in glioma patients,” CNS Oncol, vol. 3, no. 1, pp. 37–47, Jan. 2014, DOI: 10.2217/cns.13.65.

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