Expert: Claes-Gustaf Nordquist, M.D. - 4/16/2008

Question
What are my son's options with regards to treatment of his brain tumor.  We were told that due to the location of his tumor (4th ventricle) that surgery is not an option. His spinal tumors are now stable after chemo. His tumor has not changed significantly since 2002 when he was first diagnosed with just intraventicular brain tumor. Not knowing what and if we should be seeking other opinions if there are other options I would like to know. It seems from what I know about this tumor surgery is always the most favorable option. Appreciate any advice.

Answer
As in all malignant brain tumors the immediate prognosis is associated with grade. Grade is however something that is evaluated based on biopsy material or surgical material by a pathologist. In this case that seems to be unobtainable since any kind of surgery is not an option. However he has already lived for 6 years with it. That probably indicates that his tumor is a low grade one (grade 1 to 2), so not very malignant, otherwise he would probably not be alive today. Therapy for all malignant brain tumors is - if possible - a combination of surgery, radiation therapy and chemo therapy since such a combination seems to give the best results. In his case surgery is not possible so only chemo therapy and radiation therapy remain. You have mentioned chemo therapy. Has he also received any radiation therapy? If not that remains an option.  You have mentioned spinal dissemination. Some brain tumors spread that way to the spinal canal and the spinal chord by disseminating tumor cells in the cerebrospinal fluid. One way of treating that is radiation therapy. How big is his tumor?  If not too big it MAY be possible to treat it radiologically (unconventional radiology) with the so called GammaKnife, or the CyberKnife or with proton beams. That is however by no means certain. That has to be evaluated by his drs. That is about what I can tell you based on the information you have given me.