Expert: Claes-Gustaf Nordquist, M.D. - 2/9/2010

Question
My sister has recently undergone brain surgery for a stage 4 glioblastoma in her right parietal lobe.  Two weeks after surgery she began chemo (by mouth) and daily radiation with a booster at the end of her therapy.  Before surgery, she had lost some command over her left foot, hand and arm. The condition improved somewhat during physical therapy in the interim between surgery and treatments.  Now she is 10 days beyond her last radiation treatment and her mobility has worsened to the resemblance of a person who has had a stroke.  She must have help whenever she moves from one location to another due to fear of falling.  She is desperate for some hopeful information of any kind.  Her doctors have not told her what to expect from these treatments vis a vis her difficulties.  Her energy is very low (as expected).  Is it true that radiation affects your system as much as 90 days beyond treatment?  With physical therapy can she hope for improvement in her mobility?  Her speech is not affected, and difficulty remembering seems to be related to her fatigue.  Any positive words will be much appreciated.  Thanks so much, Anne

Answer
I suppose that you mean GRADE 4 glioblastoma  (glioblastoma multiforme grade 4) since malignant brain tumors rarely have stages but do have grades. And grade (grade 4 is unfortunately worst) is directly associated with prognosis. Yes radiation causes side effects (as does surgery as well as chemotherapy). Radiation usually causes brain swelling - like the inflammatory swelling a sunburn (ultraviolet radiation) may cause. That swelling can be treated with corticosteroid medication (like cortison). It is probable that her increased symptoms are caused by such swelling (can also be caused by surgery). And such swelling can be there for quite some time. Treatment with surgery, radiation therapy & chemotherapy usually eventually but temporarily will decrease symptoms and prolong survival time. But these tumors have all a very bad long time prognosis. I estimate her survival time to be around one year from primary treatment or maybe somewhat longer. I'm sorry I have nothing better to tell you!



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