Expert: Claes-Gustaf Nordquist, M.D. - 10/14/2007

Question
QUESTION: my husband has been diagnosed with anaplastic astrocytoma  grade III five years ago.It had been completly removed with surgery end then he had radiotherapy 60 gy and chemotherapy with Tamondal.Due to immunodeficiency he had infected with nocardia end had antibiotic treatment.Now on the last MRI we found a few small tumors near to each other.the neurosurgeon told us that a new surgery is not possible due to the position.Some had suggested to us gliadel waffers after a small part removal of the tumor ,others to do gamma knife, and others radiotherapy because of the possibility of the excistanse of other cells near there.They are afraid to give again tamondal because of the history of nocardia.whats your opinion ?should we choose gamma knife (the neurosurgeon accept him as a patient) or is radiotherapy better?How many times he can do gamma knife?is there a restriction about the amount of radiation he will take?it can be done again at positions close to the first?about tamondal whats your opinion in our case? thank very much for your time.Im looking forward for your answer.

ANSWER: There is a upper limit to how much radiation therapy that can be given. How much more - if any - he can take depends on how much he has received before. If his drs. are reluctant to give him more chemo therapy I can hardly object given the reasons. I would - if possible - suggest GammaKnife treatment of the remaining lesions combined - if possible - with more ordinary radiation therapy. However if this is possible remains to be seen. Please do keep me posted!


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QUESTION: If you can please take a look of his MRI at the following photoalbum http://bluelaguna94.myphotoalbum.com/view_album.php?set_albumName=album67  .
If you will had to choose either gammaknife or radiation (the combination is not possible) what whould you choose? there is restrictions to how many times he can do gammaknife ,how soon and how close to a first possition?can you tell us if you know which is the best brain tumour center in europe and how we can have an evaluation from there?

Answer
Unfortunately just the pictures are not enough for that! It has to be determined together with the radiation physicists etc. The best GammaKnife center in Europe is my old Alma Mater the Royal Karolinska Institute and the Karolinska University Hospital (Solna Campus), Stockholm, Sweden. It is where the GammaKnife was invented by the late Professor Dr. Lars Leksell, M.D., Ph.D., then professor of neurosurgery and head of the neurosurgical department of the institute (a medical university) and the hospital. That was quite some time ago. He was professor when I studied medicine there. Since I have retired I'm not completely up to date but I think I have the e-mail address of the dr. in charge of the GammaKnife there - if he is still around - somewhere here at home. If I can find it I'll come back here and send it to you! I'm not sure if he is still in charge though. If he is he is from Iceland by the way, talking almost like the old Vikings. The phone no. to the hospital exchange though is 011-46-8-51770000 (46 is Sweden and 8 is Stockholm). Please remember that Stockholm is 6 hours AHEAD of New York! However I can NOT promise that it is possible for the hospital to accept your husband though about a year ago I helped a Danish woman to get to there for GammaKnife treatment via this site. But she was a European Union citizen so the hospital could hardly refuse her. Nor can I tell you what it will cost. Probably they will insist on payment in advance. I also do not know how or to what extent such an expense will be covered by your husband's insurance but hopefully it will be. I have found my note. His name is Dr. Elfar Ulfarsson and his e-mail is elfar.ulfarsson@karolinska.se  . Good luck!