Expert: Claes-Gustaf Nordquist, M.D. - 9/4/2009

Question
My 30 yr old nephew was diagnosed with a inoperative grade 3-4/4-4 malignant astrocytic brain tumor right above the brain stem in the thallmic area.  I am just not sure of the size - I think it was about a 1.5 cm. tumor.  Initially thinking he had MS, and after numerous tests and a spinal tap, the tumor was diagnosed through a brain biopsy.  His symptons started mid-February and he was done with radiatino in May. He had 30 daily radiation treatments and is now on Temodur for 6-12 months, 5 days per month.  His last two scans have shown tremendous amounts of shrinkage. I am only aware of limited prognosis for life expectancy - any suggestions?  I am a recent breast cancer survivor - finished my radiation in March and am now on Tamoxifen for five years and know all too well the marathon fight my newphew has in store for him.  He turned 30 just after his radiation, just finished his masters, married 5 years and was trying to start a family.  Any possibility that the tumor will completely go away and stay dormant for awhile?  His MD was VERY POSITIVE after yesterdays MRI, and the MRI that was performed in July showed the area as more of a lesion than a tumor.  Thank You.

Answer
Unfortunately I'm much more pessimistic than his MD with regards to his chances. If the grade of his tumor is a 3 or a 4 it is very bad. The location you described makes the tumor inoperable directly. Radiation therapy and chemotherapy can only cause a temporary retreat of his tumor and as a consequence a relief of symptoms - also temporary. For how long is impossible to tell precisely. There are individual differences and it also depends on if it is a grade 3 (longer time available) or a 4 (shorter time available). All (almost) malignant brain tumors relapse (with grade 3 or 4 ALL do) and are then fatal. With breast cancer at least you have a reasonable chance of success. Not so here unfortunately. However his tumor was quite small - probably detected quite early due to its strategic location. That may give him extra time - but how long that may be no one can tell you.  I'm sorry I have nothing better to tell you!