Expert: Claes-Gustaf Nordquist, M.D. - 4/23/2010

Question
My friend was diagnosed in August 2008 with Grade III Anaplastic Astrocytoma in the right frontal lobe. His symptoms were: extreme headache (for at least 2 months), nausea/vomiting, "fainting spells", lack of motivation/very tearful. The tumor was not completely resected as it began to cross the mid-line into the left frontal lobe - which he was told was way to risky to try and resect. He completed radiation treatment followed by 6 months of Temodar chemotherapy.In December 2009, he began having seizures. After an MRI, he was told it was related to scar tissue, rather than regrowth, and started Dilantin, which appeared effective. However, in March 2010, a routine MRI showed tumor regrowth near the original resected tumor. Earlier in April, he underwent surgery, and the surgeons are "confident" they removed all of the regrowth. He is now considering his chemotherapy treatment options, including a clinical trial. I have read many of your responses to others who have the same type of tumor and similar treatments, and know that prognosis in general is grim. My question is, how does the prognosis change since the tumor has shown regrowth (which again was biopsied as the same Grade III AA). Have clinical trials shown to be more effective versus standard practice?

Answer
Unfortunately the prognosis of high grade (grade 3 and 4 are both high grade though grade 4 is the highest and therefore the worst) malignant brain tumors is ALWAYS bad so far. Its prognosis has not changed at all. It was bad from the beginning. What has happened now is just a confirmation of that. It seems to be following the normal time schedule of a grade III (3) malignancy of the brain. The only difference to a grade 4 is that a grade 4 moves even faster so the time schedule there is shorter. No one can at present be confident with any certainty that all of a malignant brain tumor has been removed surgically. That just happens to be the sad truth. There are some interesting animal studies going on but the change is so far only marginal and they are yet rather far from any use on humans. Otherwise there is unfortunately so far no change. And there has been very little change - if any at all - during the last 30 or 40 years in this particular field. I'm sorry I have nothing better to tell you!




You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128     There is no restriction to the number of questions there.