Expert: Claes-Gustaf Nordquist, M.D. - 10/31/2009

Question
QUESTION: my father who has been battling non-hodgkins lymphoma for 10 years was diagnosed last week with a lymphoma brain tumor the size of a walnut in the right frontal lobe.  He is 77 yrs old.  There is also a smaller one in the left frontal lobe.  His oncologist and neurosurgeon have decided to treat with radiation only.  He had been treated numerous times with chemo during active periods, but had decided back in Jan he would no longer get chemo.  I would like to know what his probable prognosis is?

ANSWER: Unfortunately it is most probably bad! But I do support the decision with regards to radiation therapy.


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

QUESTION: I spoke to my fathers oncologist today and he said he is optimistic about my father's prognosis.  Will do an MRI after his 3 wks of radiation.  Felt we could get another year.  Seems contrary to what I read on the web.  Do you concur?  He did mention that he didn't perform a biopsy so he isn't 100 percent sure that the tumor is lymphoma.  I would appreciate your opinion.

ANSWER: Well the prognosis of lymphomas is related to age. The older you are the worse is the prognosis. Your father has been battling his illness for 10 years so clearly he is not cured. And he is 77 years old. Those factors are in themselves significant. One more year may be possible but the probability of it is probably rather far from certainty. If it is not a lymphoma but a primary malignant brain tumor (or a secondary cancer) his prognosis is MOST uncertain! Or to be precise usually quite bad.



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

QUESTION: My father finished his 3 wks of radiation yesterday.  Though his mental state has dramatically improved (he's like his old self), his balance is very poor and he walks very slowly (fell for the first time yesterday).  Stairs are difficult for him.  Is this related to the radiation?  He goes back to the oncologist this week.  If MRI shows little change in the tumor size, what might be the next options?

Answer
It may be (brain swelling due to the radiation). Has he been given any corticosteroids against such swelling? Though his illness may also play a role. That his personality has returned to his old self is a good sign but we do not know how long it will last. Unfortunately if no more chemotherapy will be given there are not much options left though if this was his first radiation therapy to his head of course some more of that could be given. But if there is no change that would perhaps be of doubtful value though contradicted by the improvement of his personality.