Gamma Knife Surgery 1.5 Months After SOC (RT + Adjoint TMZ)???

[boray]

Hi,

My father was diagnosed with multi-focal methylated IDH-wild type GBM in November 2020 and had a sub-total resection in his left temporal lobe shortly after diagnosis (the other tumour was said to be inoperable).

After completing the standard 6-week radiotherapy + adjoint Temozolomide (120 mg / day) treatment on January 19th, the MRI on February 19th showed "mild progression". The medical oncologist started the 5/23 TMZ maintenance therapy (250 mg / day) which he completed end of February.as well.

Meanwhile we got a second opinion from another doctor, and he suggested that we had Gamma Knife surgery for both of the spots. However, our existing radiooncologist opposed this idea arguing that "they need to wait for at least few (6?) months prior to possible radiosurgery, and that the mild progressio could be driven by radionecrosis which she said was quite likely since we had a methylated tumour. And she suggested to wait for the next MRI scheduled in May.

My father is currently doing well apart from occasional memory problems and has been on Keppra and recently on Kordexa (dexamethasone).

Thanks for your thoughts & suggestions,

BY

[musella]

That is a hard problem - when one doctor contradicts wha tthe other doctor is advising. You can get another opinion, or use our patient navigation program and let our team look at it. (Go to https://virtualtrials.org/xcelsior.cfm to get started). My own thoughts, without looking at the medical records so this is only a guess.. I would do the gamma knife because they did not remove the entire tumor, so most likely the spots are a mixture of tumor and pseudoprogression... If you do gamma knife, might pay to look at this video https://virtualtrials.org/video2020.cfm?video=202008 and contact Dr Duma to get his opinion.

[boray]

Hi Al -- grateful for the useful links & suggestions. I have watched the webinar and found it really illuminating. Also just dropped a note to Dr. Duma via the "Contact" menu on his web site (https://www.cduma.com/) and asked if & how I could submit MRI files pertaining to the patient for Dr. Duma's assessment of his eligibility for leading edge radiosurgery. Hope to get a reply and keep you posted on the progress.

Unfortunately I cannot join your patient navigation programme as it seems to apply to the US only (whereas the patient is based in İstanbul).

Best,

Bora

[musella]

Sorry we can't serve the entire world yet..

[musella]

By the way - Dr Duma mentioned that he has a patent on the leading edge procedure. I asked him about that after the webinar. He said he did that so nobody else could patent it and it could be used freely by everyone. He is willing to share the knowledge - so you could have the gamma knife center in Istanbul contact him for advice on how to do it.