Expert: Claes-Gustaf Nordquist, M.D. - 10/15/2008

Question
QUESTION: Dear Dr. Nordquist,
I hope you are doing fine. Further to our previous correspondence regarding the brain tumor of my father, I have just received the 3rd hystological report, with diagnosis anaplastic astrocytoma 3rd grade. Which I suppose differ a little bit from the 2nd report - glioblastoma 3rd grade. Hopefully next week we start radio and chemo therapy.

ANSWER: Thanks, yes to some extent but hardly for any practical purposes! Treatment and prognosis are the same.


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

QUESTION: Dear Dr. Nordquist,
I am addressing this e-mail related to my previous questions from April this year, regarding the diagnosis of my father - Glioblastome. After the brain surgery, my father have started radio-therapy - approx. 30 times in a row. During all that time, he has been given Dexamethasone injections. I could say there was significant improvement in his behavior and adequacy. After the radio-therapy we have waited for 3 weeks and now he is through his first course of chemo-therapy with Temozolomide. However, without dexamethasone injections he is absolutely inadequate, so we keep on giving these injections. We are worried that may be there is something left from the brain tumor, because his condition is not improving and he is inadequate and losing weight. We still did not make scanner after the radio-therapy as we have been told we should wait for some 2 months. I am wondering if in this situation it is possible to have 2nd brain surgery, or should we expect some improvement from the Temozolomide.
Thank you in advance for your kind comments.

ANSWER: I'm sorry to hear this! Unfortunately treatment is not always successful even initially. I doubt any further surgery can be considered until after any new MRI scan so that the present condition can be evaluated. You should discuss this situation with his drs. Please do keep me posted!



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

QUESTION: Dear Dr. Nordquist,
Further to my previous enquiries from April and August, related to my father diagnosis - glioblastome - I would like to present you the present situation. After completing 2 courses of chemo-therapy we have made MRI scan. The scan shows there is no tumor in the brain - only a post-surgery cyst occurs. However, due to bad general condition of my father we have decided to consult with a private neurosurgery clinic. A second surgery have been completed with neuro-navigator procedure. According to the surgeon the operation has been very positive and the scan after surgery together with all analyses have been perfect. However his general condition is extremely bad: practically inadequate; aggresive; no speach at all; practically very difficult to walk; no appetite; depression and etc. The surgeon thinks it is based on some psychics problem and has no medical explanation to that. He has suggested to start with the 3rd chemo-therapy course and thinks the results will be very positive.
I will highly appreciate your comments towards this situation. We are very curious about this paradox.

Thank you in advance.
Best regards,
Krystian Tonew

Answer
I'm not sure either why his condition is so bad without any obvious tumor present. Were his surgeries extensive? After all when surgery is done in the brain many things can happen! I see no reason not to continue his chemo therapy if he can tolerate it since historical experiences with such tumors are so bad. I do hope all goes well!