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Suggest Treatment For Loss Of Strength In Limbs When Suffering From GBM Tumor
Question: This is for my Mother (63y) . Its been 16months as she's undergoing treatment for GBM tumour.Now she's losing strentgh in her right lower and upper limbs .
Questions :
* What are the best options at this point to prolong her healthy survival?
• PGI RT team had given an option to go for the second line of Chemotherapy (IV ) using a medicine named Avastin .(It might have serious side-effects) but we did not opt for it . Can it be an option now??
• If Yes , What would be the possible benefits in terms of meaningful survival ?
* What should be the appropriate dosage of dexamethasone as she seems to gain motor strength while on steroids ?
* She has started to have momentarily loss of sense Hallucinations now ( not exactly fits or seizures) , Can we do something about it ?
Questions :
* What are the best options at this point to prolong her healthy survival?
• PGI RT team had given an option to go for the second line of Chemotherapy (IV ) using a medicine named Avastin .(It might have serious side-effects) but we did not opt for it . Can it be an option now??
• If Yes , What would be the possible benefits in terms of meaningful survival ?
* What should be the appropriate dosage of dexamethasone as she seems to gain motor strength while on steroids ?
* She has started to have momentarily loss of sense Hallucinations now ( not exactly fits or seizures) , Can we do something about it ?
Brief Answer:
Difficult situation
Detailed Answer:
Dear sir/ madam,
This tumor GBM is a highly aggressive tumor. The treatment till now is good. You have done surgery, RT and chemotherapy also. So called the multi-modality treatment. But now there is large recurrence in brain. The tumor is resistant to chemotherapy- temozolomide as it has progressed on medication even.
Now let us discuss your questions.......
1. you asked about healthy survival. These 2 things are different, survival means prolongation of life. Healthy means good quality of life. So we should opt for good quality of life, not a long life with poor quality.
2,3. The option of Avastin is always open. It will prolong survival by about 2 to 6 months, different in different persons. But it is a costly drug. We should not go beyond our financial limits to get a small survival benefit of few months, without a good quality of life.
4. Dexamethasone is a steroid used to decrease brain edema. Most of the symptoms are due to peritumoral edema causing pressure effect on the adjacent brain tissue. So if you decrease edema, symptoms will decrease and quality of life will be better. The dose may increase or decrease, to be decided by consultant according to patient's tolerance, because it has got side effects also.
5. The symptoms you stated should be related to brain edema. So efforts to reduce edema will alleviate the symptoms.
Now what can be done presently........
You should understand few things.........tumor is highly aggressive, so overall prognosis is poor. At present the treatment should be directed towards palliation of symptoms, so that quality of life can be improved, with or without prolongation in life. So presently we have 3 treatment options....
1. only palliative medicines to decrease brain edema like steroids, glycerol, lacilactone etc.
2. repeat surgery just to decrease bulk of tumor (not to remove whole tumor) so that pressure effect will decrease.
3. second line chemotherapy.
feel free to ask further. ...... this is fight against God. Sometimes we win, sometimes God wins.
Difficult situation
Detailed Answer:
Dear sir/ madam,
This tumor GBM is a highly aggressive tumor. The treatment till now is good. You have done surgery, RT and chemotherapy also. So called the multi-modality treatment. But now there is large recurrence in brain. The tumor is resistant to chemotherapy- temozolomide as it has progressed on medication even.
Now let us discuss your questions.......
1. you asked about healthy survival. These 2 things are different, survival means prolongation of life. Healthy means good quality of life. So we should opt for good quality of life, not a long life with poor quality.
2,3. The option of Avastin is always open. It will prolong survival by about 2 to 6 months, different in different persons. But it is a costly drug. We should not go beyond our financial limits to get a small survival benefit of few months, without a good quality of life.
4. Dexamethasone is a steroid used to decrease brain edema. Most of the symptoms are due to peritumoral edema causing pressure effect on the adjacent brain tissue. So if you decrease edema, symptoms will decrease and quality of life will be better. The dose may increase or decrease, to be decided by consultant according to patient's tolerance, because it has got side effects also.
5. The symptoms you stated should be related to brain edema. So efforts to reduce edema will alleviate the symptoms.
Now what can be done presently........
You should understand few things.........tumor is highly aggressive, so overall prognosis is poor. At present the treatment should be directed towards palliation of symptoms, so that quality of life can be improved, with or without prolongation in life. So presently we have 3 treatment options....
1. only palliative medicines to decrease brain edema like steroids, glycerol, lacilactone etc.
2. repeat surgery just to decrease bulk of tumor (not to remove whole tumor) so that pressure effect will decrease.
3. second line chemotherapy.
feel free to ask further. ...... this is fight against God. Sometimes we win, sometimes God wins.
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
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