Expert: Claes-Gustaf Nordquist, M.D. - 2/10/2008

Question
dear dr. nordquist,
my daughter was diagnosed with malignant melanoma 3.5 years ago., (mole stage 11)(while she was pregnant) which was excised and she had a c.t.scan which seemed to satisfy the doctors that it had not spread. One month ago, after feeling extremely unwell for months, she was diagnosed with a brain tumour, which was operated on successfully, (melanoma), she has been advised to have a course of whole head radiation, which she has been dreading., as it has taken quite a while for her to feel well again., and after starting on friday, has done nothing but vomit, she cannot even keep her tablets down, I am distraught, and find it hard to believe a treatment with such severe side effects are worthwhile, what would you advise please. (I suppose what I am asking is, are the benefits worth the horrendous side effects) Should I persuade her to continue or get well enough to enjoy life with her 3 year old son for a while.?

Answer
Unfortunately I do not have a good message for you - but maybe you know some of it already. Malignant melanomas are very tricky. In this case she is now a stage 4 case since her tumor has spread to another organ. All stage 4 cases have a very bad prognosis. No surgeon can guarantee that the whole melanoma tumor in the brain has been evicted by surgery, some parts always remain. Melanomas are also usually NOT very sensitive to radiation therapy or chemo therapy. In this case though the surgeon knowing that some tumor probably remains has really no other choice than to offer radiation therapy since he does not have much else to offer. These side effects as you describe them astonish me. Yes brain irradiation can indeed cause side effects, usually in the form of a certain amount of brain swelling like an internal sun burn that can be reduced with corticosteroids, but it usually does not come this quickly. That makes me think that there may be some other cause for her symptoms and therefore you should discuss this with her drs. ASAP! Unfortunately I do not think it is possible to cure this. Survival times in situations like this are around one year or shorter. However some interesting and promising experiments with immuno therapy of melanomas are going on (with patients) at the National Cancer Institute, Bethesda Maryland and a few other places but how to get into the program I do not know unfortunately. I'm sorry I have nothing better to tell you!