Expert: Claes-Gustaf Nordquist, M.D. - 12/27/2009

Question
QUESTION: Hi, I am 42, female. I think I have a grade II insula glioma. We have tried to biopsy but have only be only to get a gleosa (a fluid filled pouch that bulged out into the templar (sorry, front lobe.) The tumor is "c" shaped and surrounds an artery. We are just waiting for growth right now, and when it grows, or I show neuro. change, start radiation treatment. Three questions- 1- should we try another biopsy? it would require a sizable opening for just a needle biopsy, and 2. Is it worth radiation vs. quality of life? Meaning, I want more good days than bad-I am told the tumor is deep to shrink, that this will just stop growth-if change has already happened, then what are doing this for? And 3. Chemo- I don't think I can handle the hit to my immune system with a past history of immune system issue, and left my first oncologist who wanted to start with low dose oral chemo, which made no sense to me with research- what do you think of that? I have been to 3 oncologist and 4 surgeons, all with different ideas and plans- what are your thoughts? I am a realist, I don't want to do things just to do them, I want happy days, not sick days. I know this is a lot to ask, so any general feedback would be wonderful. I don't think I get honest answers and I think I deserve them. Please be blunt and factual. Thank you.

ANSWER: How big is your tumor? In order to give as good an answer as possible I do need to know that. I would prefer to have a biopsy - if at all possible. But only your neurosurgeon can tell you if it is.


You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128


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

QUESTION:  4.5 cm AP x 2.7 cm transverse, approx. 3.3 cm craniocaudally, A 1.9 cm area of greater T1 hypointensity and T2 hyperintensity is present at its inferolateral margin, within the temporal lobe. No abnormal contrast enhancement was seen.  tumor encases aprox. 75% of M1 segment of the left middle cerebral artery and is closely associated with proximal middle cerebral artery branches. Together with the biopsy of the gleosa it was decided it was consistent with a glioma.
Thank you.

Answer
I see. I was considering stereotactic radiation therapy (GammaKnife or proton beams). But with these measurements it is probably too big for that. So only conventional radiation therapy remains. If I were in your shoes I would accept such treatment if the lesion starts to grow or gives symptoms. That is all I can tell you.

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128