Expert: Claes-Gustaf Nordquist, M.D. - 11/12/2010

Question
QUESTION: Here is a little information about by Daddy. He was taken in for emergency surgery Feb 02 08' for a large grapefruit sized tumor in his brain. We were told that he is lucky he didn't die because his brain had shifted and that everything was removed and it was a  benign tumor. We were relieved and felt like everything was ok. We were told to follow up in 1 year with an MRI and he should be good. So we wait 1 yr, have a follow up MRI and hear the words its back. He had to go for surgery again and have the tumor removed, it was a lot larger than they expected but it was still the original tumor, the Dr that did the emergency surgery left some of it behind under the artery in the front of his head, and didn't tell us we only found out after the second surgery. After the biopsy of that tumor we are told it is Malignant acting so its not actual cancer because its a primary tumor, but that it is fast growing so we will follow up with Radiation to be really aggressive and your father should do well. After he completed 6 weeks of Radiation we waiting 6 more months and had another MRI to find he had a tiny spot that had grown back and they wanted to do Gamma Knife just to be really aggressive. So he went through gamma knife in May of this year. Now we are at Nov, he had another MRI and we have been told they found some area's of concern and are meeting with the board to discuss further options. What can this mean? We were told they would try chemo if the gamma knife didn't work but I have read on chemo and its not that effective. Have you heard of Proton Therapy, I have been reading about it and find some very good outcomes with it? Are the Dr's just not telling us everything. I do know with Malignant Meningioma's the outcome isn't that good but I am looking for answers. My Dad is 64yrs old, very healthy and takes good care of himself. He has had no side effects from any of the procedures, and says he feels like nothing is wrong and he feels great. Please be honest with me on what you think? Thank you for your time, I understand you have a lot of expertise in this area.

ANSWER: Most meningiomas are benign but there are some - not very common - that have malignant features. Usually as seems to be the case here locally malignant (no metastases - but I can not guarantee that either). Usually that can be taken care of with radiation therapy or more extensive surgery. Here it seems to be quite tricky when neither local radiation therapy nor stereotactic radiation with the GammaKnife have been able to solve the problem. Proton beam radiation is another kind of stereotactic radiation therapy with some unique features (and needing an extremely expensive accelerator machine for its production). It is certainly not available everywhere. Here in Sweden it is only available at one place (in a country of almost 10 million inhabitants) and that is at the University of Uppsala around 40 miles north of Stockholm. Where you can find it where you are I have no idea. If it is possible in the case of your father depends on many things. The target - or targets - of the treatment must be rather small (not much over 1 inch in size) per target for the treatment to be possible. It also depends on how much radiation he has already received. There is an upper limit to how much radiation that can be given locally. So how much he has received totally in this area must be calculated. I will not hide from you that this is a HARD case and I can unfortunately not at present promise success. On the other hand I can not at present predict failure either. But the situation is very uncertain and a failure is unfortunately possible. More than that I can not tell you. Please do keep me posted!


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QUESTION: Thank you for your response, I will keep you updated. What is your feeling on Chemotherapy in this situation? With all of the research I have done I haven't found any promising outcomes from Chemotherapy? I have read they do Chemosensitivity testing to parts of the tumor that was removed to see how it reacts? Have you seen any positive outcomes with this?

Answer
Unfortunately I have not much confidence in chemotherapy for this condition. However it is a developing area so upcoming results may be better. But right now I unfortunately do not have much faith in it.
Thanks!




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