Treatment of Brain Astrocytoma in Germany

Astrocytoma is one of the two most common brain tumors, along with meningioma. The tumor can have any grade ranging from grade 1 to grade 4. Malignant tumors are more common. German doctors use neurosurgical interventions and stereotactic radiation therapy for the treatment of astrocytoma. In some university hospitals, small neoplasms are destroyed with a laser under MRI guidance.

Content

1. Surgical treatment
2. Radiation therapy
3. Laser treatment of brain cancer
4. Why is it worth undergoing treatment in Germany
5. Treatment in Germany with Booking Health

Surgical treatment

The most effective treatment method is neurosurgical intervention for neoplasm removal. Grade 1-2 astrocytomas recur extremely rarely. The surgical intervention usually cures the disease.

The prognosis is worse for grade 4 astrocytomas, which is the highest grade. These tumors are called glioblastomas. It is a very complex task to remove them completely because:

• Cancer cells spread far beyond the main tumor focus within the brain tissue.
• It is difficult to distinguish cancer from normal tissue.
• It is impossible to remove tissue with a margin, since such an approach will cause a severe neurological deficit.
• Tumor is aggressive, grows rapidly and has a high recurrence rate.

Despite all the difficulties, doctors in German hospitals often manage to remove brain cancer completely, with minimal risk of complications. To distinguish healthy tissues from pathological ones, neurosurgeons use a special contrast agent. It makes cancer cells glow.

The doctor's task is not only to remove the entire astrocytoma. It is also important to do this with minimal harm to the patient. Tumors are not always superficial. Sometimes they are located deep in the brain tissue, so the doctors have to dissect the brain tissue to get to the neoplasm. Doctors use MRI, PET and functional examinations of the brain to determine the clear boundaries of the tumor, the best way to reach it, and also to detect functionally important parts of the central nervous system that have to be avoided prior to surgery. Whenever required, doctors perform intraoperative diagnostics. Modern neuronavigation systems allow the doctors to orientate perfectly inside the patient's skull. Thanks to high-quality equipment and the professionalism of doctors, neurosurgeons in German hospitals usually manage to remove an astrocytoma with minimal harm to the patient's health.

During a neurosurgical operation, the tumor is excised with instruments. If the neoplasm has a complex configuration and is located in hard-to-reach places, doctors use:

• Ultrasonic dissection-aspiration – medical specialists destroy the tumor tissue with ultrasound, and then aspirate it out through the tube.
• Photodynamic therapy – a photosensitizer is injected, and when it accumulates in cancer cells, they are irradiated with a laser. The sensitizer activates and destroys cancer cells from the inside.
• Intraoperative brachytherapy – radioactive materials are placed in the tumor area for a short time and affect cancer cells with radiation.

With innovative technologies, German neurosurgeons can remove the astrocytoma totally but not partially, which significantly improves the prognosis for patients.

Radiation therapy

Radiation therapy for brain cancer is considered the second most important treatment. For some patients with astrocytoma, this is the primary and only way to control the tumor. In addition, radiation is provided to patients with a newly removed astrocytoma, if it is malignant. Additional cancer treatment is required to reduce the risk of recurrence and increase the recurrence-free interval.

Radiation therapy can be used in the following cases:

• In patients with benign neoplasms – only in the presence of a residual tumor (if it was not possible to remove the astrocytoma totally).
• In patients with grade 3-4 astrocytoma – radiation therapy is always carried out after surgery, and it is supplemented with chemotherapy.
• In patients with hard-to-reach or large tumors, debilitated patients who refused surgery – in all cases where surgical cancer treatment is not performed, radiation becomes the main method for tumor control.

Irradiation usually takes 5-6 weeks. Patients visit the hospital every day, 5 times a week, with a weekend break. This is inconvenient for foreign patients, since they have to spend plenty of time abroad. However, hospitals in Berlin and other large German cities often use hypofraction modes – they allow patients to undergo the course of radiation therapy faster. Irradiation options are as follows:

• Hypofractionated stereotactic radiation therapy irradiates the astrocytoma in just a few sessions (usually from 2 to 7).
• Radiosurgery is a single exposure with a large dose of radiation.

Although the idea of receiving radiation within one or more sessions seems attractive to most patients, such an approach is not always possible. The larger the tumor and the closer it is to the vital structures of the brain, the smaller the doses of radiation will have to be given. Accordingly, the longer will be the course of therapy. However, those patients with small neoplasms located away from critical areas can actually have radiation therapy within just a single session. Such modern devices as Cyberknife and Gamma Knife deliver radiation to the astrocytoma very precisely, from dozens of angles. They provide a good therapeutic result with a low risk of post-radiation complications.

In addition, proton therapy is used in several cities in Germany, including Berlin, Essen, Heidelberg. This is an innovative way to irradiate tumors with even greater safety. Protons, unlike commonly used photons, release most of the radiation only upon reaching the target. Therefore, when passing through healthy tissues, they hardly irradiate them. Thus, proton therapy is the treatment of choice for deep-seated brain tumors or those located near critical structures (for example, cranial nerves or vital centers of the brain stem).

Laser treatment of brain cancer

Since 2018, German hospitals have started destroying brain tumors with a laser under MRI guidance. This procedure is already carried out in Berlin, Bonn, Hanover and some other German cities. This minimally invasive manipulation through a hole in the skull of just over 3 mm replaces open surgery with cranial trepanation and brain tissue dissection in many patients.

The essence of the procedure: the doctor drills a tiny hole in the skull and inserts a thin fiber. He approaches the tumor and heats it up with a laser. The tissues of the neoplasm are destroyed, and the surrounding tissues are not affected by thermal effects. The procedure is performed under the MRI guidance. Doctors carefully examine the patient prior to the procedure in order to determine tumor boundaries and find out where the functionally important areas of the brain are located. Thus, specialists can avoid their damage.

To use this cancer treatment option, please leave your request on the website. We will select a hospital for you in Berlin or another city where this therapy is practiced. Laser ablation of the tumor has the following benefits:

• Minimally traumatic intervention.
• Low risk of complications.
• The possibility of destruction of even deep-seated tumors, which are difficult to reach with conventional surgical techniques.
• The patient does not need to recover for a long time.
• The shortest possible hospital stay.
• Good aesthetic result: there are no large scars on the head, the patient does not even have to shave off his hair.

Why is it worth undergoing treatment in Germany

It is better to undergo treatment of brain astrocytoma in Germany, because Berlin and other cities in this country use innovative treatment methods, which provide patients with safety and good oncological results.

There are several reasons for you to go to Germany:

• High-precision preoperative diagnostics will identify functionally significant areas of the brain so as not to damage them during surgery and to avoid the neurological deficit.
• Accurate neuronavigation and intraoperative diagnostics will reduce the risk of complications.
• Fluorescence diagnostics will help to distinguish healthy tissue from the tumor in order to remove it completely and prevent recurrence.
• Ultrasonic dissection-aspiration, photodynamic therapy, brachytherapy and other new technologies allow the doctors to remove even fragments of the tumor with an inconvenient location.
• You can undergo radiation therapy within just one or more sessions instead of a long one and a half months of irradiation.
• Advanced types of radiation therapy on modern linear accelerators ensure a minimal risk of post-radiation complications.
• Cutting-edge radiosurgical systems do not require fixing a rigid frame with screws to the patient's skull.
• German hospitals use proton therapy – the safest way to irradiate brain tumors.
• Doctors can perform minimally invasive laser ablation of astrocytoma under the guidance of MRI instead of major neurosurgical intervention.

After neurosurgery and radiation therapy in Germany, you can undergo neurorehabilitation. It will eliminate or significantly reduce the neurological symptoms that limit work capacity.

Treatment in Germany with Booking Health

To undergo astrocytoma treatment in one of the German hospitals, you can use the services of the Booking Health specialists. On our website, you can see the cost of treatment in Germany and compare prices in different European hospitals in order to book the best medical care program at a favorable price. Medical treatment in a German hospital will be easier and faster for you, and the cost of treatment will be significantly lower.

You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a free consultation on treatment in Germany. We will fully organize your trip abroad. We will provide the following benefits for you:

• We will select the best medical hospital in Germany, whose doctors specialize in the treatment of astrocytoma and achieve the best results.
• We will solve the problem of the language barrier and we will help you to establish communication with your attending physician in the hospital.
• We will reduce the waiting time for the medical care program. You will undergo treatment on the most suitable dates.
• We will reduce the price. The cost of treatment in the German hospital will be lower due to the lack of overpricing and additional coefficients for foreign patients.
• We will help you solve any organizational issues: we will draw up documents, meet you abroad and take you to the hospital, book a hotel, provide interpreting services.
• We will prepare a program and translate medical documents. You do not have to repeat the previously performed diagnostic procedures.
• We will help you keep in touch with the hospital after the completion of treatment in Germany.
• We will organize additional examination and treatment in the German hospital, if required.
• We will buy medicines abroad and forward them to your native country.

Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help reduce the cost of treatment, organize your trip, and you will only have to focus on restoring your health.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko