Expert: Claes-Gustaf Nordquist, M.D. - 5/5/2010

Question
I spoke with you in January about my husband's undiagnosed spinal tumor found on an MRI in January '09.  In February, he went in for a second MRI and the Neurosurgeon determined it was a low-grade (Grade II) spinal astrocytoma with slightly ill defined borders between the T-1 and T-4.  We also consulted a neurologist who confirmed this diagnosis.  They are unwilling to do a biopsy or surgery due to the location of the tumor.  

The problem is his symptoms are getting progressivly worse quickly.  He has tremors in his hands and legs, muscle weakness, violent chills with no fever or infection, decreased sensitization along his body, difficulty standing after sitting or laying down, occasional severe headaches and severe back pain at an 8 on a scale of 1-10 daily.

He is already on prednisone from a pancreas/kidney transplant he had in December of 2008 and has decreased immune function due to the anti-rejection medications.  His immune system has been down to dangerous levels at some points despite medication adjustments.

My questions are could it be a higher grade since the symtoms are accelerating so quickly?  My understanding is that all grades of spinal tumors enhance in MRIs and the neurologist said it is definitely growing.  Could the low immune system be contributing to the growth?  Finally, how serious is this?  He will not do chemotherapy or radiation as it would affect his transplant, so we need to know what our options are, if any.  

Thank you so much for your help.  Unfortunately I can find a lot of data on brain astrocytomas, but very little on adult spinal astrocytomas and the doctors have not done much beyond confirming what we already knew and determining that it has not spread.

Answer
Well experience of situations like that of your husband is quite limited so it is hard to give sure answers.  Grade is always hard to determine with precision so it is in principle possible that his tumor grade is higher but not necessarily so - due to the very limited margins of growth his tumor has due to its location. With all these troubles his prognosis is unfortunately quite bad. Stereotactic (CyberKnife or proton beams) radiation therapy MAY be possible but I can NOT promise that. Apart from that - if at all possible which is uncertain - there is unfortunately not much - if any at all - that I can suggest. I'm sorry I have nothing better to tell you!




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