Expert: Claes-Gustaf Nordquist, M.D. - 12/2/2009

Question
Dear Dr Nordquist,
My husband (age 32) was diagnosed with an inoperable brainstem glioma (no biopsy, but believed to be grade 1) in 2008. He had regular radiation for 5 weeks. The tumor shrank with app. 25 % following the radiation, and the next 3 MRIs showed that the remaining cells were dying. It is about 2 cm. However, in September the MRI showed slight growth, mainly in the cystic component. He started with temodal, but the doctors is not sure if it is working. Until September he had no symptoms, but a few days after he started with temodal his right side became weak and his speech is a bit slurry. We believe that this is caused by the temodal and not the tumor itself (this is not similar to his original symptoms). We asked about other treatments besides chemo. One oncologist said that radiosurgery is not possible because of the location, meanwhile another one said it is possible, but may be problematic since he had radiation in 2008. I am confused because I read on the internet that brainstem gliomas is being treated with radiosurgery in the US and elsewhere. I know that it is rare for adults to get brainstem gliomas, and I am worried that the expertise with this is limited in Norway. Gammaknife or cyber knife is not available in Oslo. Do you have any experience with sterotactic radiosurgery for low grade brainstem gliomas?

Answer
Du får mycket gärna skriva på norska. Jag har inga problem med vare sig bokmål eller nynorsk.I personally do not have that experience, but as a Norwegian I do not think that there would be any problem for your husband to be treated in Sweden, for example with the Gamma Knife (Leksells kula) in the Karolinska University Hospital. I have helped a couple of Danes to be treated there. And I think that with the EU/EES rules any Norwegian could be helped there. But call the Karolinska Hospital 0046851770000 and talk to the department of neurosurgery that is in charge of this. I can not promise that it will work but I think it is well worth to find out! Lykke till/Good luck!

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