My father has been diagnosed with a brain stem glioma recently. It has been noted to be a Grade 1 tumor. (I can provide a link to the MRI and PET scan for more details.)

 The doctor we are talking to is recommending a CT biopsy followed by Cyber Knife radiation therapy. This is a neuron-surgeon at the Apollo Hospital in Chennai India. We are concerned about the biopsy as the glioma is located in the brain stem. They have mentioned that there is a 2% risk in performing this procedure.

He has been taking steroids: Neksium, Omnacortil since 40 days but no reduction in the lesion has been noted. Can you please advise if doing a biopsy would be absolutely necessary, and if not, what are the alternatives?

Further, What is the cost to do Cyber Knife in the US approximately? Just so we can get an idea. It is $10,000 USD in India.

Are there any other advanced procedures to do a biopsy in the US – could you please provide some information about this?

Any further information you can provide would be much appreciated.

Please advise.

Thanks.

MP

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

Dr. Clinton,

Thanks very much for your reply.

What is your opinion of risk in a CT aided biopsy procedure? What would be the alternatives for this?

Standard fractionation treatment is not one that has been suggested by any of the doctors we have spoken to. If you could provide any further information about this, it would be most helpful.

Thanks.

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

Dr. Clinton,

Since my last question, my father underwent a biopsy and following that a 6 week 3D conformal radiation treatment on the Linac. His radiation sessions ended on Jan 19, 2010.

The neurosurgeon we were consulting has said this treatment is only palliative and there is no assurance of when there will be a relapse. We have been told that it will be atleast 1-2 months before we see any improvent in his symptoms so that is when an MRI is to be done and provided.

Current condition of my father: He has a tracheostomy tume, feeding is through ryles tube, since the last 2 weeks he was suffering from intense lower back pain. This was found to be a minor fracture in one of his lower vertebrae but we are unsure of how it happened. He is quite immobile now, and body waste is also through a condom catheter and diapers.

His physical energy levels are low but thoughts are lucid and he communicates well by writing.

Since the completion of the course of radiation therapy, we have moved him to another hospital at a second place as we have family support here.

The consulting neurosurgeon here is suggesting the use of a chemotherapy drug Gliotem (temozolamide) to arrest the growth of the glioma.

The radio oncologist from the previous hospital who had prescribed the radiation treatment had preferred not to use any chemo drug in this case. When we checked with him, he said that the hospital has a policy not to use this particular drug. He also thought that this drug is more useful for high-grade gliomas.

We were hoping that previous MRIs and the biopsy report would assist the doctors in letting us know whether it is right to use this drug or not.

We are unsure whether at this point we should start with this chemo drug or not. Can you please advise.

I can provide any medical reports for your information.

Thanks very much.

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

Thanks very much for your response Dr. Clinton.

The drug is to be admininstered for 5 days every 28 days and apart from nausea and vomiting, could have side-effects like:

If your blood count falls you may experience the following:

·         White Blood Cells (WBC). Shivering or shaking attacks of fever. If you feel hot or unwell check your temperature.  If it is 38°C (100F) telephone the Hospital and they will advise you. Do not take Paracetamol or Aspirin if you have a temperature.  A raised temperature indicates infection which could be life threatening. If you have a temperature or feel unwell contact your hospital immediately.

·         Haemoglobin (Hb) Tiredness, lethargy, breathlessness, dizziness (particularly on standing) and pale facial colour. Occasionally patients require a blood transfusion. 

·         Platelets If you notice any bleeding, i.e. nose bleeds, unexplained bleeding, bruising or persistent headaches contact the Hospital immediately.

Can these side-effects be countered easily? Therefore, is it still worth a try?

Thank you.

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102