Expert: Claes-Gustaf Nordquist, M.D. - 5/30/2008

Question
My husband was diagnosed with a glioblastoma multiforme in Jan. 2008. This diagnoses was based on an MRI with and without contrast.It showed a "butterfly" tumor in the right and left frontal lobes. At that time a biopsy was done and the result came back only showing necrotic cells. Seven samples were taken from the right lobe. They gave a prognosis of 3 months. He was treated with 24 days temador concurred with 31 days of radiation.The MRI 4 weeks after completion of treatment shows no change. He is also on 6 mg. of decadron, which has caused a moon face, bloating in the stomach and muscle loss in the legs and arms. The oncologist suggest that he be put on temador for 5 days on 23 days off. Regarding quality of life the radiation oncologist suggest that due to the fact he sleeps, cannot work, confused, needs help with daily task (bathing dressing), if it is quality of life that we are looking for that another round of chemo may not be beneficial. There are days he is wheel chair bound and need help getting up. With quality of life being his most important issue less time is better if he can spend those days with enjoyment. I ask you two questions please first does necrosis always mean malignant, and is it fair to stop treament and live the remaining time his way not his physicains way? He does know it is terminal, so they say, and just wants to enjoy days remaining?

Answer
In a situation like this the patient always has the right to refuse tratment. Necrosis MAY indicate malignancy BUT is NOT proof. To be sure you do need a cellular material showing cellular architecture and even better if also tissue archtecture can be evaluated! THAT is absolutely necessary! However an MRI scan showing a picture highly suggestive of glioblastoma multiforme is also important even if not an absolute proof!
When he sleeps most or even more so all the time or has entered a coma the end is near.