Expert: Claes-Gustaf Nordquist, M.D. - 1/24/2009

Question
QUESTION: My friend has "4 separate enhancing mass legions the largest is 3 cm involving the right ventral thalamus."  They believe this is metastatic.  The results of the x-ray on her body are inconclusive.  They are doing a pet scan on Monday. If we find the source is the size of the cancer too large to do anything anyway?  Is a gamma knife an option?  If they cannot find the source what are our options?

ANSWER: The GammaKnife is in this case probably a PALLIATIVE option NOT a CURATIVE one! Since they are several lesions they are probably metastatic. Well since the cancer in that case already has spread it would anyway be rather academic and no cure would be possible. The ONLY option here in either case is palliative care. A cure remains impossible in either case unfortunately. I'm sorry I have nothing better to tell you! Ordinary radiation therapy to the brain is also a palliative option.


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

QUESTION: Dr.  Do you have any idea how much time we have?  Do the benefits outweigh the negative from radiation? Only when she wakes up she is confused but she has full motor skills.  How long will she be coherent with a 3cm tumor on her thalamus and 3 others?

Answer
Both tumors and patients are individuals not identical copies/clones. So to predict both survival time and coherent time is most uncertain. But even with therapy I unfortunately expect her survival time to be measured in months certainly not in years. Her coherent time will be quite shorter. Without treatment these periods would be quite shorter still. So yes there is a gain with radiation therapy and the negative effects of radiation therapy are really not that bad (I'm not only a radiation therapist myself, I'm also a patient - right now I'm undergoing radiation therapy for prostate cancer and I did the choice myself between that treatment and surgery well knowing what I did). Unfortunately at present no cure is possible. I'm sorry I have nothing better to tell you!