Expert: Claes-Gustaf Nordquist, M.D. - 7/31/2008

Question
QUESTION: Is Whole Brain Radiation appropriate for a small lesion in the brain when there is no involvement in other parts of the brain.  Non-Hodgkin Lymphoma patient.  I'm leery of the after effects and am inclined to go for focal radiation to the effected area.

ANSWER: Experience has clearly shown that whole brain radiation generally is better in these situation than focal radiation for the simple reason that there may be more smaller lesions present, too small to be detected! But of course the choice is yours, but it is best based on reality.
For my credentials, please read my bio page here! What it is based on? Around 40 years of oncology & radiation therapy experience! And the knowledge that radiology examinations can NOT show microscopical tumor cell deposits that can grow later! That is why a whole brain therapy has a better chance than a local therapy. If you do not believe me check with your own dr. If he and I are in agreement at least you will know that we are!


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QUESTION: how do you justify the neurological damage to the brain after WBT.  you seem to have skirted that issue DOCTOR

Answer
Not at all! You are in a Scylla & Charybdis situation (caught between 2 dangers with no "ideal" solution). If you are given ONLY local treatment, so less neurological damage is done by radiation AND you have tumor cell deposits elsewhere in your brain - at present undetectable - that are therefore not treated, these deposits will cause you brain damage as they grow! Besides THAT will lessen your chances of a cure too! And they will anyway be treated with WBT further down the line but with worse results! So take your pick. However you turn your backside will always be at your back!