COMPREHENSIVE REVIEW OF HIGH-GRADE ASTROCYTOMA GRADE III: ANAPLASTIC ASTROCYTOMA – PREVALENCE, PATHOLOGY, TREATMENT, AND RECURRENCE

Abstract

Anaplastic astrocytoma (AA), classified as a Grade III high-grade astrocytoma by the World Health Organization, represents a significant subset of malignant brain tumors. This literature review aims to provide a comprehensive overview of AA, covering its prevalence, types, pathological features, treatment modalities, and recurrence patterns. AA primarily affects adults between the ages of 30 and 50, with a slightly higher incidence in males. The tumor is characterized by increased cellularity, significant nuclear atypia, and brisk mitotic activity, distinguishing it from lower-grade astrocytomas. Pathologically, AA displays heterogeneity in molecular alterations, including mutations in the IDH1 and IDH2 genes, loss of heterozygosity on chromosome 10, and alterations in the p53 pathway, contributing to its aggressive behavior and resistance to conventional therapies. Standard treatment involves maximal surgical resection followed by radiotherapy and adjuvant chemotherapy with temozolomide, which has been shown to improve progression-free survival. Despite aggressive treatment, recurrence is common, often progressing to glioblastoma multiforme, a Grade IV astrocytoma, which portends a poor prognosis. Recent advancements in molecular profiling and targeted therapies offer hope for improved management and outcomes. Ongoing research into the tumor microenvironment and immunotherapeutic approaches holds promise for future therapeutic strategies. This review underscores the need for continued exploration of innovative treatments and personalized medicine to enhance survival and quality of life for patients with anaplastic astrocytoma.