Expert: Claes-Gustaf Nordquist, M.D. - 8/15/2009

Question
Dear Dr,

My uncle has been diagnosed with GBM in the thalamic region. Please would you let me know what would be the actual prognosis. What are the best treatments possible. Please let me know.

Below is the MRI scan report.

Technique : Plain  + i.v. contrast
Axial : T1, T2, FLAIR, DWI, GRE, T1C
Sagittal : T1, T1C
Coronal : T2, T1C
MRS : Single and Multi-voxel; 35ms

" Large well defined intra-axial mass lesion in the left thalamus measuring approx 47x44x37mm. the lesion is slightly heterogenous; predominantly hypointense on T1W1 and hyperintense on T2W1. There are two small irregular ring-like enhancements within the lesion measuring approx 24x22x21mm (superior) & 23x23x17mm (inferior). MRS shows prominent choline peak. Features are s/o GBM/high grade glioma. There is replacement/compression of third ventricle; B/L lateral ventricles are mildly dilated(VHR 36% at frontal horn level) with peri-ventricular T2 hyperintensity. Cerebellum, midbrain, pons and medulla are normal. "  

Answer
If the diagnosis of a high grade glioblastoma multiforme is correct - which is very probable but only sure if confirmed by a pathology biopsy - then his prognosis is very bad REGARDLESS of treatment. Treatment consists of surgery (may however be impossible in this case with a location in the thalamus region), radiation therapy & chemotherapy. It can however not cure him. Only temporarily decrease his symptoms and to some extent prolong his survival time. Even with full treatment I unfortunately doubt that he will live much longer than a year. I'm sorry I have nothing better to tell you!