Expert: Claes-Gustaf Nordquist, M.D. - 1/31/2008

Question
QUESTION: This is a followup question. Thanks so much for previous responses! I found out that Medicare, Mom's primary insurer will not pay for inpatient PET scans, they can only be done as outpatient. It's a stupid system. Mom after being in the hospital 16 days has been discharged to a skilled nursing facility for rehab.(PET scan can't be done while in the SNF either.) She has been referred to the Moffitt cancer center in Tampa for further outpatient consult with a neuro-oncologist. The doctors believe she has metastatic brain cancer but still are not convinced of it as the MRI scan showed multiple ring enhancing lesions but no edema and they said not typical for cancer necessarily. They think an outside chance some oddball disease is going on. Infection seems to be ruled out with spinal tap, culures, etc. So hope that the new MDs will offer brain bx as current neurosurgeon doesn't feel necessary and wants to start radiation therapy. What a frustrating situation, meanwhile she continues to deteriorate.  Thanks very much for your input.

ANSWER: I'm sorry for your idiotic insurance problems. I do hope it will be taken care of better there. I personally would hardly irradiate without biopsy evidence or something else of a convincing nature!


---------- FOLLOW-UP ----------

QUESTION: Hi again--Thanks for previous answers. Now Mom has completed her 10 days of radiation therapy today. A second neurosurgeon has consulted and agreed that no biopsy is needed and 95% chance this is indeed metastatic brain cancer, even tho no other cancer has been found in her body. My question is--how soon would any beneficial effects of radiation be apparent? She has been on 16 gm Decadron for the last 3 weeks, seemed to be improving at first but now is more and more confused and sleepy and almost not talking at all. We are taking her home with hospice in a few days. Just wondering if I should push to get her more Decadron or if the radiation could take longer to have an effect.
Thanks very much.

Answer
You SHOULD start to see some effects by now though they may be hidden due to the brain swelling effect by radiation that Decadron is supposed to counteract. You will have to discuss with her drs. if a higher dosage is advisable. However a good effect of radiation can not be guaranteed since we do not know what kind of cancer we are dealing with. If these for example are metastases from a colon cancer or from a malignant melanoma there would hardly be any positive effect of radiation at all since these tumors are usually not very sensitive to radiation. That is one of the reasons why I would hesitate to irradiate without having biopsy results indicating that that would be a good idea.