Expert: Claes-Gustaf Nordquist, M.D. - 2/17/2009

Question
QUESTION: My husband ad a Pineal tumor at the age of 12 and receive Colbalt radiation for treatment.  Doctors now say because of his treatment it caused his stroke in 2005 and has now caused his GBM.  My husband has been through so much in his life and we want to make the most of the time that we have left together which is my question. Prior to his diagnosis he didn't have any direct symtoms, he went in for a check up because he works construction and his muscles were getting sore and I felt he had a lost muscle in his legs.  What they originally found was that his Patuitary Gland was pretty much shut down and put him on numerous medications.  As an after thought they did a CAT scan (he is unable to have MRI's due to a metal shunt from his first tumor) what they found was GBM.  He had surgery to have as much tumor removed as possible, they believe 90-95+ %.  Since the surgery he has gone through the Temador/Radiation (lover dosage then usualy due to prior radition)treatments and the tumor did not grow back during this time.  However, since his scan on 02/10/09 he has had a constant headache in and behind his left eye (the tumor is on the right side behind his ear).  The unknown is very difficult for both of us.  We have asked his doctors but they won't give us a straight answer.  We want to know what time frame he has left so we can plan accordingly by traveling and enjoying each other as much as possible but still having to make a living at the same time.  I've read all the information on life expectancey but nothing says anything about if someone has had a prior brain tumor and radiation which we've been told does change the odds.

ANSWER: There are NO known causes for malignant brain tumors so we can actually not be sure that his GBM was caused by his earlier irradiation. The same goes for his stroke. GBM tumors all have very bad prognosis but survival time depends largely on the GRADE of the tumor. You have not mentioned his grade which makes it difficult to give you any kind of prediction. Treatment is of course also of importance and here not a full radiation therapy could be given which is not good. But in order to be able to predict in any way I do need to know his tumor grade!


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

QUESTION: I'm sorry, we were told that by calling it GBM that it meant Glioblastoma Grade 4.  Today he is going on his 5th day of having a terrible headache.  His doctor upped his dosage of Decadron from 4mg a day to 16mg a day which we hope will help.  He is such strong stuborn man that he's been working through all the pain.  Thank you for any insite on a time line that you can give us.

Answer
GBM means glioblastoma multiforme but the grade must still be added. OK so it is a grade 4. In that case his survival time - even with full therapy - is at most around one year or so. Here probably somewhat shorter since full therapy can not be given but by how much is impossible to say. There is ALWAYS an uncertainty factor involved in such predictions, here that one is a little bigger.