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Q&A Sessions: Astrocytoma

John Y.K. Lee, MD, Assistant Professor of Neurosurgery, is the Director of the Penn Center for Cranial Nerve Disorders and a national leader in treating cranial nerve disorders.

Debbie asks:
I have a 21 year old son who has been diagnosed with astrocytoma glioma Grade II. As I understand it, surgery is not an option due to the extent of the tumor. A physician at NIH is recommending treatment with Temodar. Another physician at Johns Hopkins is recommending radiation or "wait and see". They have been monitoring this for about a year with very little, if any, growth. He appears normal in every way except for 20-30 second episodes of inability to speak with accompanying "tingling" sensations. Is he a candidate for the gamma knife procedure. Thank you.

Dr. Lee responds:
Gamma Knife Radiosurgery is occasionally performed for grade II astrocytomas, but most patients usually undergo a fractionated treatment such as what is being offered at JHU.

Angie asks:
My father was diagnosed with a grade 3 anaplastic astrocytoma. I know what and how the Gamma Knife works (I had it for an arteriovenous malformation). Can this be used for my father? If so, what are the statistics with this?

Dr. Lee responds:
Gamma Knife radiosurgery can be used as an adjunct to conventional treatment strategies for patients with anaplastic astrocytomas. Each situation is different and depending on the clinical status, location of the tumor, and age of the patient, different modalities may be utilized. This decision should be made in conjunction with your father's neurosurgeon and radiation oncologist.

If you would like to discuss this further, please call 1-800-789-PENN (7366) and ask to be connected to Dr. John Y.K. Lee's office. You can also request an appointment online.

Amit asks:
My friend is recently diagnosed with neoplasm astrocytoma. Below is her MRI report:

Findings:

  • Lobulated solid cystic lesion is noted in the right temporo-parietal region. There is nodular enhancing solid component and peripherally enhancing cystic components. It measures 5.4 X 5 X 3.6 cm in its craniocaudal, Trans and AP dimensions. There is overlying thickening and meningeal enhancement in this region.
  • Extensive perilesional edema is noted. There is effacement of the overlying cortical sulci and the right occipital horn.
  • There is no shift of the midline structures.
  • There is no other focal area of abnormal signal intensity in the cerebral or cerebellar hemispheres. The grey-white matter differentiation is well maintained.
  • The ventricles, cerebral sulci and the basal cisterns are normal.
  • The basal ganglia, thalami, brainstem and cerebellum appear normal.
  • Para nasal sinuses appear normal.

Conclusion:

  • Lobulated solid cystic lesion in the right temporo-parietal region with overlying meningeal thickening and enhancement.
  • Extensive perilesional edema. Effacement of the overlying cortical sulci and the right occipital horn.
  • Possibility of neoplasm like Astrocytoma appears likely. However, infective process like conglomerate tuberculomas cannot be entirely ruled out in view of adjacent meningeal enhancement.
  • Correlation with Spectroscopy and SOS biopsy is recommended.

The doctor has suggested to go for an immediate surgery. I want to know whether gammaknife can be used in this case? Also if you can tell what is normal survival rate post treatment in this type of cases.

My friend is in India. If you can suggest any clinic in Mumbai, India or anywhere in India for Gamma Knife will be great. I can bring her to US if she has sufficient time for treatment. Appreciate if you can give your views or suggestions.

Dr. Lee responds:
Given the size of the lesion and lack of clear diagnosis (infection versus tumor), the best course of action is most likely surgical. Obviously it is difficult for me to determine the specifics without more detail.

Joe asks:
I was wondering if Gamma Knife is successful in treating/curing grade I pilocytic astrocytomas. My tumor (pilocytic astrocytoma) is 1.9 x 3.2 x 2.5 cm in the CC, AP, and TV dimensions respectively (no associated cyst). Furthermore, it is in a subcortical location adjacent to the hippocampus in the right temporal lobe.

Dr. Lee responds:
There are only a few patients who have been treated with Gamma Knife radiosurgery for juvenile pilocytic astrocytomas. The data suggests that it can arrest tumor growth, but only increased follow-up and time can be sure that this strategy will work. I would be happy to see you in consultation.

If you would like to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Dawn asks:
Are there any areas of the brain where you cannot use Gamma Knife treatment? For example, if you have an astrocytoma near your brain stem.

Dr. Lee responds:
There are several areas of the brain that are more sensitive than others, eg. optic nerve, brainstem. However, this does not mean that the Gamma Knife is not an option. It does mean that careful planning must be performed by the neurosurgeon and radiation oncologist.

For more information or to schedule an appointment, call 1-800-789-PENN (7366). You can also request an appointment online.

Peymaan asks:
I am 44 years old and have been diagnosed to have 2 low grade Astrocytoma in the left temporal frontoperietal area in left insular region with extension to the opercula. I undergo MRI every six months which shows no changes to the last one for the past 4 years, and signal intensity of lesion is low on T1W & low on T2W. I do suffer from Partial Seizures, few times of the Complex type. Despite taking medicine I do have my epileptic seizures almost every day and I am seriously.

I am serously considering the Gamma Knife Surgery for which I need your professional comments.

Dr. Lee responds:
There is not a lot of data regarding Gamma Knife for low grade astrocytomas, since nobody has a large experience treating patients like you. Nevertheless, there is definitely evidence that radiation therapy can improve time to progression for low grade astrocytomas, and Gamma Knife is a particularly effective method for small, benign tumors.

Please feel free to contact me by calling 1-800-789-PENN (7366) as I am able to review your films prior to your having to come down for an actual consult.

Jade asks:
My brother-in-law was diagnosed with a/b brain tumor. The histologic changes are consistent with glioma/anaplastic astrocytoma. Can this procedure help him?

Dr. Lee responds:
Gamma Knife radiosurgery can be used as an adjunct to conventional treatment strategies for patients with anaplastic astrocytome. Each situation is different and depending on the clinical status, location of the tumor, age of the patient, different modalities may be utilized.

Please feel free to call 1-800-789-PENN (7366) for more information or to schedule an appointment. You can also request an appointment online.

Erin asks:
I am 25 and I have been diagnosed with an astrocytoma. Do you feel that the Gamma Knife would be right for me?

Dr. Lee responds:
There are at least four types of astrocytomas: juvenile pilocytic astrocytoma, fibrillary astrocytoma, anaplastic astrocytoma, and the most aggressive kind which is glioblastoma multiforme. Each one is treated differently. In addition, each patient is treated differently based on age, presentation, location, etc.

Please feel free to call 1-800-789-PENN (7366) to schedule an appointment. You can also request an appointment online.

Robin asks:
I have an astrocytoma that was treated with radiation in 1999. It has become malignant and I am currently taking temodar. I have inquired about Gamma Knife with my doctors and they tell me that my tumor is too large for Gamma Knife. My tumor is 4cm x 3cm x 4cm. Is this too large for Gamma Knife?

Dr. Lee responds:
The size of the tumor is an important consideration in whether to proceed with Gamma Knife radiosurgery. However, there are several other important variables such as location, alternative options, type of tumor, etc. Please feel free to call 1-800-789-PENN (7366) and ask to be connected to my office. You can also request an appointment online.

Donna asks:
Is Gamma Knife treatment good for patients with astrocytoma brian tumors -- a fast growing tumors that originalted within the frontal loge of the brain?

Dr. Lee responds:
Gamma Knife radiosurgery can be used to treat patients with astrocytomas; however, it is generally reserved for use after conventional craniotomy and resection and after conventional external beam radiation therapy.

Pat asks:
My brother-in-law has undergone radiation treatment for a level II astrocytoma. After six weeks of therapy, he was told that a cyst surrounding the astrocytoma had grown. They are now recommending aspiration or surgery. Is Gamma Knife surgery an option for him, even though radiation was not successful?

Dr. Lee responds:
Gamma Knife has been used to treat grade II astrocytomas with some limited success. However, Gamma Knife cannot treat the cysts. Another option is direct aspiration and instillation of a radioactive agent such as P-32. This can be used to control cyst growth.

Feel free to call 1-800-789-PENN (7366) and ask to be connected to my office for a consultation. You can also request an appointment online.

Rick asks:
My 12 year-old daughter had a 5.5cm pilocytic astrocytoma surgically resected (craniotomy) from her left posterior frontal lobe last year and successfully recovered with no neurogical deficits. Eight months later, a second 1.3cm tumor was found during a follow-up MRI in her right temporal lobe. Her susceptibility appears to be related to an NF-1 diagnosis.

Would Gamma Knife radiosurgery be recommended for removal/control of this second tumor? Would a biopsy be required? Does the WADA test provide useful information for gamma knife radiosurgery? Please recommend the best (age appropriate) gamma knife center for treatment, preferably in California.

Dr. Lee responds:
In general, tumors in children are best treated with conventional surgery and resection. In certain cases, however, Gamma Knife radiosurgery can be a useful and effective adjunct treatment.

Cindy asks:
My daughter (16) was recently diagnosed with JPA in her cerebellar region, 1.8 cm near midline. Is this procedure something we could consider.

Dr. Lee responds:
Juvenile pilocytic astrocytoma has been successfully treated with the Gamma Knife radiosurgery. However, surgery is generally the best option. Gamma Knife can be considered if a residual or recurrent tumor is found. This decision should be made in conjunction with your neurosurgeon and radiation oncologist and possibly your oncologist.

If you would like to discuss this further, please call 1-800-789-PENN (7366) and ask to be connected to Dr. John Y.K. Lee's office. You can also request an appointment online.

Melissa asks:
My fiance recently had neurosurgery to biopsy a mass that was found in his left frontal lobe. Unfortunately, the tumor was not able to be completely removed. He was diagnosed with a grade three astrocytoma and is due to undergo six weeks of radiation and one year of chemotherapy (Temodar). Could the Gamma Knife be an alternative form of treatment instead of the radiation and chemo combination?

Dr. Lee responds:
Gamma Knife radiosurgery can be used to treat gliomas; however, I would not recommend replacing your current treatment with Gamma Knife. Instead, I would continue your radiation treatments and Temodar. Gamma Knife can be considered in the future for salvage therapy for residual or recurrent tumor.

 


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Gamma Knife and Leksell Gamma Knife are U.S. federally registered trademarks of Elekta Instrument S.A., Geneva, Switzerland. Photo credits: Susan Pardys, Elekta, Inc.

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