Expert: Claes-Gustaf Nordquist, M.D. - 11/30/2008

Question
My 61 year old husband was diagnosed Aug 2008 with Gliobastoma Multiforme, Grade IV.  He had a total gross resection, and has had 6 weeks of radiation and chemotherapy, and is now started back on chemotherapy 5 days per month.

His latest post treatment MRI "looks good" according to the neuro-oncologist - there is no sign of new growth or swelling.

Yet ----he has had several focal seizures in the past few weeks, and has never regained energy since his radiation protocol 6 weeks ago.  He is tired all day long and virtually is housebound - going from bed to couch, with the occassional "good day" where he may go out to lunch with a friend and a brief walk.  Aside from that, he remains a semi invalid, in my opinion.

My question is: why is he still in such a confused, tired state, several weeks post radiation, and with  a clean MRI? If I didn't know better, I would think the cancer had spread and he was failing, and yet ----all "looks good".  Is it possible that there are cancer cells that are creating symptoms, yet are still too small to show up on MRI?  Do other patients exhibit seizures and  such fatigue and deficits post radiation?

Thank you for your answer.

Answer
ALL brain tumor patients of this kind do show some symptoms after treatment. Brains are harmed by the tumors even before treatment and that can rarely be put right. You are probably also right in your assumption that there still are cancer cells there - though still too small to be detected - since these tumors still do have a bad prognosis regardless of treatment. So sooner or later the tumors come back.
I'm sorry I have nothing better to tell you!