Hi all, my brother diagnosed with gbm last year april 2016 and got his surgery, radiation and temodal immediately after that. This year around feb 2017 during his 3months mri checkup the doctor noted a 0.75cm mass suspected as gbm. Bc its too small the doctor decided to wait for next mri to see how it goes. At may 2017 my bro undergo another mri and found out it was clear! But at next mri aug 2017 they found the 'dissapeared' mass to have grown to 1.4cm. The doctor have decided that it must be gbm recurrence, and he said that the missing mass in between these mri must be the gbm 'hiding'. Is it really possible gbm to be 'missed' during mri?
And we also really confused to the best solution in handling this 'possible gbm recurrence'. We have asked diff doctors including neurosurgeons and oncologists. Doctor A said we should go with gamma knife, Doctor B said we should go with Surgery instead cause Gamma knife wont guaranteed as clear as Surgery. Doctor C said Surgery is dangerous cause the mass is in a critical location that can 'paralyzed', and Gamma knife not effective so we should go with Cyberknife instead. Anyone who have experienced gamma or cyber which one is actually more effective for gbm? And for gamma knife do the patient need to undergo chemotherapy after the gamma knife operation like using Avastin? Or they can only wait for the gamma to works? We really appreacite any recommendations or sharing of experience. Thank you!
Regards,
Milee
It does sound quite strange that a tumor disappears in one MRI and reappears in the next one. If you do get a consensus that this is true recurrence, one of the best outcomes I've seen for recurrent GBM came from a small retrospective (only 11 patients) who underwent Gamma knife radiosurgery followed by Avastin and chemotherapy. These outcomes were compared with patients who only had Gamma knife without Avastin.
ReplyDeleteMedian progression-free survival was 15 months, which is probably the best PFS statistic I've seen for recurrent GBM. All the usual caveats apply because this was a retrospective study not a clinical trial. The median time from diagnosis to treatment with Gamma knife was 17 months, which means this group probably had less aggressive disease than the average clinical trial group, as the majority of patients were at first recurrence when treated with Gamma knife, and median time to recurrence for GBM is much shorter than 17 months.
Still, the results are impressive and its worth considering Gamma knife followed by Avastin. I would also consider low dose Avastin combined with an ACE inhibitor, which I've posted about previously on this blog.
The study abstract is here:
https://www.ncbi.nlm.nih.gov/pubmed/22057917
and I can email you the full study if you'd like to read it.
Where does your brother live? There may be clinical trials worth considering.
Hi Stephen,
DeleteThank you very much for your thorough opinion and recommendation. It really help us a lot as we struggle with the diff doctors' opinions. We are residing in Indonesia, and we are open to any promising clinical trial maybe around Asia. We possibly might go with gamma-knife as it seems to be more effective than the cyberknife, hence, may I ask what are the example of ACE inhibitor you mentioned above?
Regards,
Milee
MRI pictures of brain are done in "slices", which are apart few mm. For example on my MRI exams the pictures were around 3-5 mm apart, depending on where the MRI was taken. So the tumor might be in between these slices if that tumor dimension was smaller than the distance between 2 slices.
ReplyDeleteHi Matzaj,
DeleteThank you very much for your explanation. May I ask so does it mean the 'gbm' could really 'hiding' between mri slices?
Regards,
Milee
I'm no expert, but I think that could be a possibility if it was small enough...because as Stephen said it is strange that tumor disappears and then reappears. Do you know if the imaging was done in all 3 planes (axial, coronal, saggital) ?
Deletehttps://sites.google.com/a/wisc.edu/neuroradiology/image-acquisition/the-basics
Maybe try to get a second opinion?