Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.110 Astrocytoma - Grade III and IV
COMPASSIONATE ALLOWANCE INFORMATION
ASTROCYTOMA - GRADE III and IV
Astrocytoma is a tumor that begins in the brain or spinal cord in small, star-shaped cells called astrocytes. Grade III Astrocytomas are moderately malignant. Astrocytomas include anaplastic astrocytomas and sometimes the less malignant of the glioblastoma multiforme group. Grade IV Astrocytomas are highly malignant and include only glioblastoma multiforme types. Cerebellar astrocytomas start in the cerebellum, which is located at the lower back of the brain. The cerebellum is the part of the brain that controls movement, balance, and posture. These tumors affect both adults and children. About 15-25% of all childhood brain tumors are cerebellar astrocytomas. Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma. The symptoms of astrocytoma vary and often depend on an individual's age and where the tumor is located. Symptoms include: loss of balance, trouble walking, worsening handwriting, slow speech, morning headache or headache that goes away after vomiting, nausea and vomiting, unusual sleepiness or change in energy level, change in personality or behavior and other unexplained weight loss or weight gain.
Astrocytoma Grade III: anaplastic astrocytoma, anaplastic malignant astrocytoma, Astrocytoma Grade IV: glioblastoma multiforme(GBM), glioblastoma, mixed glioblastoma sarcoma, gliosarcoma astrocytoma grade IV, giant cell glioblastoma astrocytoma, spongioblastoma multiforme
DIAGNOSTIC TESTING AND CODING
Diagnostic testing for astrocytoma includes: an examination of the brain and spinal cord, CT scan and MRI (magnetic resonance imaging). In some cases, it is preferable to obtain diagnostic information from CT scans or MRIs rather than from a biopsy. Astrocytoma is removed by surgery. If a brain tumor is suspected, a biopsy is performed.
Treatment depends on the location of the tumor and its progression. Standard treatment is surgery followed by radiation therapy. If surgery is not an option, radiation therapy is given. Chemotherapy is sometimes given during or after radiation therapy.
Astrocytomas tend to grow and become more malignant over time. Brain stem gliomas have relatively poor prognoses. The overall median survival is between 44 and 74 weeks.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: A pathology report. If a pathology report is unavailable a surgical report or all radiological studies especially the MRI and CT scans may be substituted.
Suggested Listings for Evaluation:
Pathologically confirmed or clinically diagnosed astrocytoma or glioma of the brain stem or thalamus (independent of grade).
Astrocytoma or glioma that recurs or progresses following initial therapy, independent of grade or location.