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Frequently Asked Questions About Brain Tumors and Treatment - By Dr. Arenson

  1. Do I have an incurable type of brain tumor?

    Curability of brain tumors, no matter what the grade, is uncertain, What is certain is that cure is not possible unless it is the goal. Many programs do not believe these tumors are curable and, therefore, offer treatment which has no chance to achieve this goal. For cancers where curability has been established, there is one common denominator, combination chemotherapy. There are no predictable exceptions to this rule. Thus, we treat our patients with combinations of drugs known to have activity against brain tumors. Whle our results are too new  to establish that we have indeed achieved cures, the superior overall survival and the growing number of patients surviving longer than expected suggest that many may never experience recurrence of disease and may be cured. We are convinced that our strategy for cure is the correct one. Last September, we invited 96 patients who had survived at least 3 years from the diagnosis of a grade III or IV primary brain tumor to our Annual Survivors' Party.                                                              

  2. How will taking an aggressive approach to treatment affect my quality of life, since I might not survive?

    We are convinced that the main threat to quality of life in patients with central nervous system tumors is the tumor itself, seldom the treatment. If the tumor grows, it is certain to cause major functional changes such as changes in speech, thinking and memory, and movement. Therefore, treatment, if successful in controlling the growth of the tumor, even if it has side effects, is more likely to preserve or improve quality of life than to degrade it. Of course, there are some patients who tolerate treatment poorly. In these cases, rather than continuing with intolerable side effects, we modify the treatment until it is tolerable.

  3. How important is it to remove all of the brain tumor?

    Surgery is always the first step. Occassioally, only a small biopsy can be done safely, but this is never ideal. For all grades of gliomas including grade II (low grade), grade III (anaplastic glioma), and grade IV (glioblastoma mulitforme), there is strong evidence that those patients with the least tumor remaining after surgery have the best survival. This is especially true when the post-surgical treatment is effective. Biospsy also carries the risk of wrong diagnosis since so little tissue is obtained. In order to assure that the best operation possible is done, patients should, if possible, have their surgery in centers where there is a focused program for brain tumors with the expertise and technology necessary to insure the best result. This includes the presence of a full-time neuro-oncologist.  Imaging, i.e. MRI scanning with modern capabiities such as quantitative perfusion, functioal localization, and tractography, has become essential to optimizing safe surgery. As part of any consultation that we do, we will evaluate the surgical result and recommend additional surgery when appropriate. We are part of a small network of physicians around the country who do this kind of work and, thus, can frequently aid in selection of the best place to have initial or repeat surgery if it cannot be done here. 

  4. What is the best treatment available for my tumor?

    At the present time there is no established best treatment program for this disease. What is crucial in making a decision about where to be treated and what treatment to choose is to find a place that offers a comprehensive program with a multidisciplinary team of professionals who commit most or all of their time to treating patients with central nervous system tumors. Such places are much more likely to take an aggressive approach to treatment, beginning with surgery and continuing with radiotherapy, chemotherapy and biological therapy. It is also important to select doctors who are flexible enough to adapt their treatment to the individual patient’s needs rather than relying on rigid standards and protocols. As shown in our Results section, we have results which we believe are the best currently available. We are happy to discuss this with you in person. 

  5. What do you and your program do to help support brain tumor patients and their families?

    In our program, we believe that supportive care is equal in importance to the medical treatment component. We therefore offer a variety of services to help patients and families which are not usually found in medical practicesThese include a monthly support group for patients and caregivers, a monthly interfaith healing service led by me, a social worker who is also our patient care coordinator who can help with a variety of life issues, a program assistant who provides frequent communication and information to our families and organizes our monthly interdisciplinary conferences, nutritional counseling, neuropsychologists to assess cognitive function and provide counseling, massage therapy and an annual “Celebration of Life” program in the Spring.We also have active participation in a program called “Reel Recovery” which provides fly-fishing experiences for men with cancer. We are particularly committed to helping patients feel connected to each other and, through our healing service, to a higher power, which we believe greatly improves the chances for a better outcome.

  6. What should I do about the alternative approaches that I have heard so much about, and how should I deal with people who are pushing me to explore these approaches?

    I tell my patients that it is important for them and for their treating physicians to be open-minded. I seldom tell my patients not to do some alternative treatment that they are interested in. However, medicine must be approached as scientifically as possible in order to assure patients that their treatment is both safe and effective. Therefore, I emphasize those alternative approaches that are more concerned with the motivational and spiritual needs of healing rather than those treatments where actual medicine is used. Unproven medicines can be harmful and can interfere with more proven treatments. Nevertheless, I work with people through this problem with an eye toward individualizing their care and providing what seems to work best for each patient.

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