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My Mom Aged 50yrs Suffering From Left Frontal Benign Stage-II(Atypical) Meningioma What Is Cause?
Question: Hi,
This is regarding health issue of my mom aged 50yrs suffering from Left frontal Benign Stage-II(Atypical) Meningioma from last 5+ years. Brief history of the case is as follows:
August 2012 (Surgery-I)
Pre Diagnosis: She was very fit & active in all her activities. She had no symptoms as such.
Diagnosis : On a fine day, suddenly she got fits/seizures and when CT scan was performed, it was diagnosed with Tumour in brain which was there from last 4 years and had grown in significant size and pressuring other parts. This made mom's right side semi paralysed with difficulty in speaking. So, doctor suggested for an immediate surgery.
Post-Surgery: Doctor couldn't remove tumour completely because of its position(sticked to CNS) and sent the tumour samples to Biopsy. Even post-surgery, mom was unable to use her right half and had difficulty in speaking. For which, doctor said it will improve upon time and by doing physiotherapy.
Biopsy Result: Tumour turned out to be Grade/Stage-I benign tumour and doctor suggested us to not to worry about residual part and it will have less impact as its benign and stage-I tumour and asked to continue the anti-seizures medicines.
Interim:
She was getting unpredictable seizures even after continuing the prescribed medicines and we used to have monthly/quarterly check-ups with the surgery doctor and also MRI scans with/without contrast whenever suggested. Every time he used to say its normal but mom was experiencing very bad days with unpredictable seizures.
April 2014 (Surgery-II)
Pre Diagnosis: As always seizures strike again and this time it was non-stop and continuing for an hour which turned into 2, 3 hours and had to admit her again :(
Diagnosis: It got to know from MRI Scan that tumour’s size again got increased and this time tumour branched out and created sub tumours in different directions and again doctor suggested for surgery, as tumour was too reactive.
Post-Surgery: Again, doctor couldn't remove tumour completely and sent the tumour to biopsy. This time also it had impact on the right limbs.
Biopsy Result: Tumour has upgraded his stage and its now identified to be Stage-II Benign and Atypical tumour which has good chances to recur at a rapid rate. So suggested Radiotherapy right after surgery.
May 2014 (Radio Therapy)
Treatment: 35 days Rapid XXXXXXX Radiotherapy started and mom had to visit for treatment sessions.
Post-Treatment: As usual, she had to experience worse side-effects of the treatment and the seizures have become quite common for her.
Interim:
She was getting unpredictable seizures even after continuing the prescribed medicines and we used to have monthly/quarterly check-ups with the surgery doctor and also MRI scans with/without contrast whenever suggested. Every time he used to say its normal but mom was experiencing very bad days with unpredictable seizures.
May 2017 (Hospitalization-I)
She again was getting prolonged seizures and had to hospitalize her for some time and doctor has added 2 more medicines to the list and again assured that its quite common and normal. But, it was horrible experience even to see. Imagine how bad it would be
for mom.
August 2017 (Hospitalization-II)
She again was getting prolonged seizures and had to hospitalize her for some time and doctor has added 1 more medicines to the list and the same thing is going on.
July 2018 (Repeated MRI)
Repeat of MRI has been performed with contrast. Reports showing substantial increase in the size of the 3 tumors. On consultation with Neurosurgeon who is dealing with this case since inception, suggested SRT(Stereotactic RadioTherapy) as the surgery seems to be not worthy considering tumors location and moms health.
Queries which I now have are as follows:
1. How fruitful is the Craniotomy for 3rd time and why the doctor did not go ahead with surgery followed by SRS/SRT.
2. How correct is it to go for SRT for large(9 cms in 1 dimension) and multiple tumors.
3. How different is SRT from Rapid XXXXXXX RT which was performed initially.
I asked for some time for me to decide and hence looking forward for good experts suggestions and help.
Any suggestions/help would be greatly appreciated.
Thanks a lot in advance,
This is regarding health issue of my mom aged 50yrs suffering from Left frontal Benign Stage-II(Atypical) Meningioma from last 5+ years. Brief history of the case is as follows:
August 2012 (Surgery-I)
Pre Diagnosis: She was very fit & active in all her activities. She had no symptoms as such.
Diagnosis : On a fine day, suddenly she got fits/seizures and when CT scan was performed, it was diagnosed with Tumour in brain which was there from last 4 years and had grown in significant size and pressuring other parts. This made mom's right side semi paralysed with difficulty in speaking. So, doctor suggested for an immediate surgery.
Post-Surgery: Doctor couldn't remove tumour completely because of its position(sticked to CNS) and sent the tumour samples to Biopsy. Even post-surgery, mom was unable to use her right half and had difficulty in speaking. For which, doctor said it will improve upon time and by doing physiotherapy.
Biopsy Result: Tumour turned out to be Grade/Stage-I benign tumour and doctor suggested us to not to worry about residual part and it will have less impact as its benign and stage-I tumour and asked to continue the anti-seizures medicines.
Interim:
She was getting unpredictable seizures even after continuing the prescribed medicines and we used to have monthly/quarterly check-ups with the surgery doctor and also MRI scans with/without contrast whenever suggested. Every time he used to say its normal but mom was experiencing very bad days with unpredictable seizures.
April 2014 (Surgery-II)
Pre Diagnosis: As always seizures strike again and this time it was non-stop and continuing for an hour which turned into 2, 3 hours and had to admit her again :(
Diagnosis: It got to know from MRI Scan that tumour’s size again got increased and this time tumour branched out and created sub tumours in different directions and again doctor suggested for surgery, as tumour was too reactive.
Post-Surgery: Again, doctor couldn't remove tumour completely and sent the tumour to biopsy. This time also it had impact on the right limbs.
Biopsy Result: Tumour has upgraded his stage and its now identified to be Stage-II Benign and Atypical tumour which has good chances to recur at a rapid rate. So suggested Radiotherapy right after surgery.
May 2014 (Radio Therapy)
Treatment: 35 days Rapid XXXXXXX Radiotherapy started and mom had to visit for treatment sessions.
Post-Treatment: As usual, she had to experience worse side-effects of the treatment and the seizures have become quite common for her.
Interim:
She was getting unpredictable seizures even after continuing the prescribed medicines and we used to have monthly/quarterly check-ups with the surgery doctor and also MRI scans with/without contrast whenever suggested. Every time he used to say its normal but mom was experiencing very bad days with unpredictable seizures.
May 2017 (Hospitalization-I)
She again was getting prolonged seizures and had to hospitalize her for some time and doctor has added 2 more medicines to the list and again assured that its quite common and normal. But, it was horrible experience even to see. Imagine how bad it would be
for mom.
August 2017 (Hospitalization-II)
She again was getting prolonged seizures and had to hospitalize her for some time and doctor has added 1 more medicines to the list and the same thing is going on.
July 2018 (Repeated MRI)
Repeat of MRI has been performed with contrast. Reports showing substantial increase in the size of the 3 tumors. On consultation with Neurosurgeon who is dealing with this case since inception, suggested SRT(Stereotactic RadioTherapy) as the surgery seems to be not worthy considering tumors location and moms health.
Queries which I now have are as follows:
1. How fruitful is the Craniotomy for 3rd time and why the doctor did not go ahead with surgery followed by SRS/SRT.
2. How correct is it to go for SRT for large(9 cms in 1 dimension) and multiple tumors.
3. How different is SRT from Rapid XXXXXXX RT which was performed initially.
I asked for some time for me to decide and hence looking forward for good experts suggestions and help.
Any suggestions/help would be greatly appreciated.
Thanks a lot in advance,
Brief Answer:
3 rd craniotomy operation was not required
Detailed Answer:
Hi
After hearing your mothers history the third craniotomy operation was not necessary due to the location of the tumour
The doctor should gave gone for surgery after SRT as it decreased size of the tumour
SRT for large and multiple tumours is very good and has a response rate of 75%.
SRT delivers precise delivery of radiation in 2- 5 treatment sparing the nearby normal organs whereas rapid RT delivers a sculpted tightly focused beam of radiation directly to a tumor in less than two minutes.
This may result in better tumor targeting and less damage to surrounding healthy tissue
It also may reduce the amount of time a patient spends in radiation treatment
Regards.
3 rd craniotomy operation was not required
Detailed Answer:
Hi
After hearing your mothers history the third craniotomy operation was not necessary due to the location of the tumour
The doctor should gave gone for surgery after SRT as it decreased size of the tumour
SRT for large and multiple tumours is very good and has a response rate of 75%.
SRT delivers precise delivery of radiation in 2- 5 treatment sparing the nearby normal organs whereas rapid RT delivers a sculpted tightly focused beam of radiation directly to a tumor in less than two minutes.
This may result in better tumor targeting and less damage to surrounding healthy tissue
It also may reduce the amount of time a patient spends in radiation treatment
Regards.
Above answer was peer-reviewed by :
Dr. Kampana
Thanks for the response Doctor.
Could you please elaborate on the following statement-
"The doctor should gave gone for surgery after SRT as it decreased size of the tumour."
And also few more queries adding on to earlier ones are as follows. It would be good if could you respond inline to the queries.
1. Does SRT reduces size of tumor
2. Whats the tendency of SRT to control the recurrence of tumor.
3. What are possible side effects of SRT
4. Are there any advance treatment which can completely cure such kind of tumors.
5. Is there anyway to know the Grade of the current tumors at this point of time.
6. Dr. suggested for 30 sessions of SRT, is it something different from what you were referring as 2-5 sessions?
7. Will SRT improve already semi-paralysed neurological state of the patient.
Thanks,
Could you please elaborate on the following statement-
"The doctor should gave gone for surgery after SRT as it decreased size of the tumour."
And also few more queries adding on to earlier ones are as follows. It would be good if could you respond inline to the queries.
1. Does SRT reduces size of tumor
2. Whats the tendency of SRT to control the recurrence of tumor.
3. What are possible side effects of SRT
4. Are there any advance treatment which can completely cure such kind of tumors.
5. Is there anyway to know the Grade of the current tumors at this point of time.
6. Dr. suggested for 30 sessions of SRT, is it something different from what you were referring as 2-5 sessions?
7. Will SRT improve already semi-paralysed neurological state of the patient.
Thanks,
Brief Answer:
SRT reduces tumour size
Detailed Answer:
Hi
I have gone through your attached reports.
As SRT reduces tumour size it makes easy for oncosurgeon to operate
Parasaggital meningioma has a very good response rate with SRT and tumour size reduces by 25%
SRT controls recurrence in these type of tumours by 45%.
Side effects of SRT are hair loss in the treatment area, eating and digestion problems,
mouth problems and difficulty swallowing, nausea and vomiting, soreness and swelling in the treatment area.
Advanced treatment of this type of tumour include chemotherapeutic agents including hydroxyurea, have been used for recurrent disease with marginal efficacy.
As the molecular pathogenesis of meningiomas is elucidated targeted drug therapies may prove useful.
Angiogenesis inhibitors agents that target fundamental cell signaling pathways, somatostatin analogues, and a variety of other molecular treatments appear promising.
You can discuss it with your doctor
Grade of the tumour can only be found out by surgery and sample sent for biopsy.
SRT delivers precise delivery of radiation in 2 to 5 treatment and long radiation sessions not required
Yes SRT should improve semiparalysed neurological state of the patient along with physiotherapy
Regards
Dr Monish De
Oncologist
SRT reduces tumour size
Detailed Answer:
Hi
I have gone through your attached reports.
As SRT reduces tumour size it makes easy for oncosurgeon to operate
Parasaggital meningioma has a very good response rate with SRT and tumour size reduces by 25%
SRT controls recurrence in these type of tumours by 45%.
Side effects of SRT are hair loss in the treatment area, eating and digestion problems,
mouth problems and difficulty swallowing, nausea and vomiting, soreness and swelling in the treatment area.
Advanced treatment of this type of tumour include chemotherapeutic agents including hydroxyurea, have been used for recurrent disease with marginal efficacy.
As the molecular pathogenesis of meningiomas is elucidated targeted drug therapies may prove useful.
Angiogenesis inhibitors agents that target fundamental cell signaling pathways, somatostatin analogues, and a variety of other molecular treatments appear promising.
You can discuss it with your doctor
Grade of the tumour can only be found out by surgery and sample sent for biopsy.
SRT delivers precise delivery of radiation in 2 to 5 treatment and long radiation sessions not required
Yes SRT should improve semiparalysed neurological state of the patient along with physiotherapy
Regards
Dr Monish De
Oncologist
Above answer was peer-reviewed by :
Dr. Prasad
Thanks for the answers doctor.
Below are the queries. Request you to please answer inline.
Is it possible for you to predict the current tumor grade looking at the reports as i do not want to take the biopsy path currently.
What is the difference between SRS and SRT as i have been told that the SRS take a XXXXXXX of 5 session and SRT goes for around 30 sessions depending upon the patient tumor condition. I want to know if its info is right.
Can you explain about necrosis as i am being told that there are chances of necrosis being develop after SRT but am unclear on what is it exactly. I would also like to know how it impacts the body and what can be done pre or post the treatment to minimize its ill effects.
Below are the queries. Request you to please answer inline.
Is it possible for you to predict the current tumor grade looking at the reports as i do not want to take the biopsy path currently.
What is the difference between SRS and SRT as i have been told that the SRS take a XXXXXXX of 5 session and SRT goes for around 30 sessions depending upon the patient tumor condition. I want to know if its info is right.
Can you explain about necrosis as i am being told that there are chances of necrosis being develop after SRT but am unclear on what is it exactly. I would also like to know how it impacts the body and what can be done pre or post the treatment to minimize its ill effects.
Brief Answer:
Grade is 2
Detailed Answer:
Hi
The grade of the meningioma is grade two.
As compared to previous MRI brain the current brain lesions have increased in size.
SRS and SRT are very similar but SRS delivers a large dose of radiation on a single day and SRT has a fractionated treatment schedule
In SRT the dose of radiation dose is delivered over a course of several treatment sessions, instead of all at once.
With SRS the full radiation dose is delivered in one session. Most patients can be treated as outpatients, and can return home immediately after the procedure.
The chances of of necrosis after SRT is 25 % and it usually develops within 1 to 2 years of radiation.
Pre SRT to prevent necrosis course of steroid like dexamethasone can be taken.
Post SRT necrosis can be treated with hyperbaric oxygen therapy
Regards
Dr Monish De
Oncologist
Grade is 2
Detailed Answer:
Hi
The grade of the meningioma is grade two.
As compared to previous MRI brain the current brain lesions have increased in size.
SRS and SRT are very similar but SRS delivers a large dose of radiation on a single day and SRT has a fractionated treatment schedule
In SRT the dose of radiation dose is delivered over a course of several treatment sessions, instead of all at once.
With SRS the full radiation dose is delivered in one session. Most patients can be treated as outpatients, and can return home immediately after the procedure.
The chances of of necrosis after SRT is 25 % and it usually develops within 1 to 2 years of radiation.
Pre SRT to prevent necrosis course of steroid like dexamethasone can be taken.
Post SRT necrosis can be treated with hyperbaric oxygen therapy
Regards
Dr Monish De
Oncologist
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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