Expert: Claes-Gustaf Nordquist, M.D. - 11/16/2008

Question
QUESTION: I wrote to you a while ago concerning my daughter, who had surgery to remove a brain tumour,(met.melanoma), because she was having horrendous side effects from the radiotherapy following surgery., she has managed to complete this course of treatment with the aid of steroids and numerous anti-emetic drugs..but is feeling extremely unwell, and is now devastated because her oncologist is suggesting chemo, which he previous said they would not recommend.  As her condition is stage IV and her her prognosis is poor, should she not be allowed to recover from this treatment and spend some quality time with her young son, rather than go through a treatment that will cause her tremendous distress and add to her problems a hundred fold...she now feels obliged to do whatever is proposed for the sake of her young child, but what would you recommend in the circumstances if it were your daughter please. (there are no other tumours detected at this time)

ANSWER: THAT was a hard question! I MAY recommend it for a daughter trying every possible option, but I'm not sure. For myself, probably not. I would probably stay around as long as it seemed to be of value to me and then exit by using my own revolver on myself - I'm now VERY frank with you.
Neither radiation therapy nor chemo therapy are usually of any great value when treating malignant melanoma. Has her dr. noticed that her melanoma is more sensitive to radiation than usual and is hoping the case will be the same with chemo therapy? Otherwise it is hard for me to understand his change of opinion.


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QUESTION: Thankyou for your very frank answer,(the chemo suggestion has been shelved, by the way!) my daughter is, however still feeling extremely unwell , although her ct scan is clear., (she is awaiting results of an mri) she has felt a lot worse since coming off the steroids., I am aware that the dosage must be reduced very slowly to avoid serious complications, (the family seem to assume she has become 'addicted' to them,and that she is not in her right mind, as she is a extemely adamant about most everything these days..her personality has definately changed, but in the circumstances I can understand this.,  but I feel she may be right and that resuming the tablets and reducing again might help her., what is your opinion please, many thanks, sammi  (p.s. I am convinced that WBRT in her case was a big mistake)I also read somewhere that a build up of dead cells  caused by WBRT can create similar symptoms as the original tumour., is this the case please.?

ANSWER: Ok. You are welcome. We have to wait for the result of her MRI brain scan! The slow reduction of her steroids is due to the fact that her adrenal glands (on top of her kidneys) get "spoilt" by her medication and more or less stop their corticosteroid hormone production. It takes time for them to wake up again which is the reason for the slow reduction of her dosage. So it is really no addiction! Under the circumstances I think a lot of personality change is understandable. I'm not sure if your steroid scheme is of any merit. I think it is best to discuss that with the dr. in charge of her treatment. No treatment benefits from a back seat driver with limited information! Well with regards to her brain radiation therapy. Such treatment can cause the brain to swell - like an internal sun burn. That swelling can give symptoms like a brain tumor. It is to counter that effect that steroids are given as medication. Otherwise radiation does not cause any tumor like symptoms. A killed off tumor anywhere may continue to cause tumor like symptoms until the tumor tissues have been eliminated - but that is NOT caused by the radiation.


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QUESTION: hello again,  my daughter is now in hospice as she has multiple mets to brain liver and spine..she is relatively comfortable on pain meds but has severe pain down her right leg due to the spinal tumour., she has been managing to go home for a few hours a day this past week  to spend with her young son., but has now developed problems with passing urine,( they are fitting a catheter today.), and are suggesting radiotherapy to help these symptoms., what my question is, is will this possibly help at all, I am aware that melanoma is not very responsive to rad.therapy or chemo. and is it only going to put off the inevitable..and for how long?.she is very upset and will not know the best thing to do.,as she had such a bad experience with wbrt before, what would be your advice please...many thanks, once again, sammi

Answer
Radiation therapy of the spine is MUCH less troublesome than of the brain so she should NOT compare them. How much help it will give her though is unfortunately an entirely different matter and very uncertain. If her lesion is small enough and its location permits it (probably most tricky) intense local radiation with the CyberKnife may be of better help. Melanomas are more sensitive to that kind of treatment. Her urine problems are probably associated with her spinal problems.