Chemo on Grade 2?

Derek · Posted: Mon Apr 16, 2007 3:04 am Post subject: Chemo on Grade 2?

Hello,
I was just wondering if there is any value in use of chemo on grade 2 glioma after surgery.
Our neurosurgeon doesn't seem to think it is warranted (or radio for that matter) for my wife who had complicated neurosurgery late last year.
Intuitively I don't really know if this is a good idea, it's like waiting for it to see if it come's back and increases in grade.
The most recent MRI looks ok, but at the time the surgeons' felt it was probably only a 99% resection.
The defintion of malignant verses benign seems to be an ambiguous one in this instance, since Grade 2's still come back (that is not benign in my book)
What do others know, or have done for themselves or a loved one?
Derek

rlee · Site Admin Joined: 15 Jan 2006 Posts: 245

Derek,
Good question and I'm not sure what's best. Because of this, I'd recommend a 2nd opinion at an academic center that has experience with your type of situation. Good luck.
_________________
RLee, MD

Any information provided is NOT intended to provide specific medical advice to users but rather to provide users with information to help them better understand their health condition and related care. All readers are strongly encouraged to consult with a qualified physician for answers to their personal medical questions.

brainman · Posted: Thu Apr 19, 2007 2:41 pm Post subject: Re: Chemo on Grade 2?

Derek, I totally agree with Dr Lee… you need a second opinion. My case was almost the reverse of your wife’s situation. I too originally (1992) had a grade 2 glioma. However, rather than risking the damage that surgery might cause, my doctor recommended chemo first with close follow-up using MRI to make sure the cancer was not growing. I did have a biopsy first to make sure it was cancerous and not a benign tumor and the chemo almost killed me. However, after 2 months of chemo, no living cancer could be seen on the MRI. I continued for almost a year on chemo and remained cancer free until June 2005 when it recurred. This time I did have surgery and radiation therapy… no chemo. And here I am… almost 2 years later with no signs of recurrence. Each of us is different with different types of cancer in different areas of our bodies. So these decisions should be made between the patient and the doctors. I will keep you and your wife I my thoughts and prayers.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Derek · Posted: Fri Jun 22, 2007 5:28 am Post subject: Re: Chemo on Grade 2?

Hi all,
Sorry for the late response to the original post.
We have only just been to see a Medical Oncologist,.
They of course think quite differently to Surgeons, and give virtually no hope of a surgical cure to ANY glioma.
Whilst an oligodendroglioma ( with 1p and 19q co-deletions), has a reasonably good response to Chemo, we were advised not to go ahead until there is a recurrence.
Whilst chemo may increase the length of time before any sign of recurrence, using up your "trump cards" too early apparently limits your options further down the track.
I have to agree on this one, even if initially one may think that hitting something while it is already down, might yield a more productive outcome.
He was still only talking about single digit figure survival outcomes, which is not real good when you are still only in your 30's. You can only take this on face value.
I don't think there is any right or wrong answer to this (chemotherapy), but if anyone has any alternative ideas please let me know.
Derek

brainman · Posted: Fri Jun 22, 2007 6:22 am Post subject: Re: Chemo on Grade 2?

Wow, Derek, it has been a long time Very Happy

. I had to read your initial post to refresh my memory on the details of your wife's case.

One clarification question: Did you get a second opinion or was this the original oncologist? If it is the original oncologist, I would still get a second opinion about it.

I am confused because you said that, unlike the surgeon, the oncologist said to wait on the chemo until it recurred. Am I reading you correctly? If it is the medical oncologist telling you to wait, a second opinion might not be necessary. However, if the medical oncologist is being over-ruled by the surgeon, that is a different story! The surgeon is an expert in what surgically can be done; the medical oncologist is an expert in what chemotherapy should be used. Hopefully and, in my experience, usually they work as a team and will clarify why they are making this recommendation to you. However, in your wife's case it sounds like the surgeon is calling all the shots. That is wrong! He might be right, but that is not his call to make. He can advise the medical oncologist, but he should not be dictating the decision. I might be totally misunderstanding what you are telling us. If I am, I am sorry. But I still stand by my original recommendation of a second opinion.

As for the single digit survival outlook... my medical team told my that there was only a 90% chance that I would live 10+ years... that was in November 1992!! And !@#$&^ I am still here Very Happy

. Don't bury me or your wife until we are dead!
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Derek · Posted: Fri Jun 22, 2007 9:07 pm Post subject: Re: Chemo on Grade 2?

Thanks Brainman,
First of all, this is the first Medical Oncologist specialist we have been to, and they have had little or no communication with the Surgeons. (Except a faxed copy of the Case History and Pathology Reports).
He did offer referral to a another Oncologist Specialist in Sydney for a second opinion, but I don't know whether we are prepared to jump into further treatment just yet (unless there was a chance of actually curing this disease), as my wife does have some post-surgical difficulties. (Due to haemorrhage and meningitis).
Apparently anaplastic (ie Grade 3) tumours are more responsive to Chemo anyway. My gut feeling is if this tumour eventually returns and/or increases in grade, which all gliomas invariably do, then hit it hard with something like TMZ then - which oligo's are very sensitive to.
Finally "Survival Statistics" is something I take with a grain of salt anyway. You are a living testament to this.
Derek

brainman · Posted: Fri Jun 22, 2007 9:39 pm Post subject: Re: Chemo on Grade 2?

Derek, it sounds like you and your wife have given this a lot of thought and I do not know if I where in her situation I would not make the same decision. I did not know about her post surgery complications! That and the fact the chemotherapy is not easy are real big factors. Be assured that I am keeping you and your wife in me thoughts and payers.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

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