Expert: Claes-Gustaf Nordquist, M.D. - 12/2/2007

Question
QUESTION: My husband was dx with gbm IV in april of 07. surgeon said it was unusual because cystic and round (predicted it was benign before surgery), but after path. said definitely gbm IV.  husband did the standard 6 wks chemo/radiation, followed by chemo 5 days month.  tumor recurred 11/07.  surgeon predicted it wasn't tumor because it was hard and round, suggested possible radiation damage. he said he had to break it in five pieces to get it out and untangle it from blood vessel.  got the path results and he determined that it was gliosarcoma this time, again saying it was unusual.  he's told us "unusual" enough that I wonder if he actually knows what it is. He also said the prognosis for gliosarcoma was better than for gbm IV, but I see nothing to support this.  Is the prognosis better? Is my husband's case really something unusual?  Thank you for your help.

ANSWER: Well, I was not there so I do not really know how it appeared. Maybe its appearence led him to believe it was something else than what it was. But once the diagnosis was made I'm not surprised by the clinical course that followed. A glioblastoma multiforme grade IV has a 100% mortality rate regardless of therapy. Therapy can for a time relieve symptoms and it can prolong survival that is unfortunately all. As far as I see it the moment that diagnosis is made (if correct) fate is at present sealed. How things later may appear does not really matter. That is of no concern for the prognosis of this kind of tumor. So far he is exactly following the course that can be expected with this initial pathology diagnosis. So unfortunately his survival time at best can be measured in months rather than years. I'm sorry I have nothing better to tell you!


---------- FOLLOW-UP ----------

QUESTION: thank you.  if the second one is gliosarcoma though, is the prognosis any better at all?

Answer
As I wrote the second diagnosis does not change anything at all! Had it been the first diagnosis (instead of GBM IV) there would have perhaps been a SMALL change to a somewhat longer survival time but hardly enough to matter (and still a 100% mortality rate). Almost all really malignant brain tumors have a bad prognosis. The grade level mostly only indicates that those with a lower grade will survive longer than those with a higher grade.