Expert: Claes-Gustaf Nordquist, M.D. - 5/3/2009

Question
QUESTION: My 86 year old mother just had a grade III or IV glioma, probably GBM IV, removed. At this point, she is well oriented and alert. Temador and stereotactic radiation is being recommended. Prediction is 6 months without treatment and 12 to 16 months with treatment. If final pathology results indicate Stage III, then maybe 3 years with treatment. My mom originally presented with expressive aphasia, disorientation and marked agitation. No visual symptoms or motor impairment at all. Her medical history is otherwise unremarkable, except for well-controlled hypertension, elevated cholesterol and sciatica. Understanding that everyone's course is individual and it is more difficult to predict with brain disorders, can you share your impressions about what we might expect her short and long term course to look like. How much might the treatment protocol help control symptoms? This information would help us think about cost-benefit of the chemo and radiation (side effects vs. symptoms) vs. no treatment. Thank you so much for providing this valuable service.

ANSWER: I agree in general with the evaluation given by her drs. No detailed evaluation can be given due to individual differences. But let me put it this way. If she happened to be my own mother I would - with my knowledge of brain tumors, their bad prognosis and their treatment - without any doubt agree to the suggested treatment in spite of the fact that a real cure is not possible at present. Both my patients died of cancer and apart from being a cancer dr. I am also a cancer patient myself. My radiation therapy for prostate cancer was recently concluded.



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

QUESTION: Thank you, so much for your kind, thoughtful and timely response. Of course, I wish you the very best with your situation. Cancer is a scourge. I will encourage her to accept treatment. Can you say anything about what we can expect down the road -- agitation, severe disorientation, seizures and likely cause of ultimate demise or is it just too individual to do so? I'm trying to get my mind about what we are most lilely to be heading into. Thank you, again.

Answer
Thanks! Over time she will become more & more confused, may develop stroke like symptoms and even epileptic fits. She will sleep more and more. When she sleeps all the time her end is near. She will then drift into a coma and then pass away. There will be little pain - if any.