Recurrent Malignant Brain Tumours - Should I go for surgery or wait till they grow larger

Hi. The type of treatment appropriate for those multiple brain tumors would depend on the histology of those tumors. My assumption is that all the seven brain tumors would have a similar histology. My question is: did those brain tumors originate from the brain itself? Or do these represent metastatic lesions from the olfactory neuroblastoma? It would probably be helpful if you can provide any biopsy or histopathology report of the previous instances of brain tumor in 2000 and 2004. If the seven tumors are neuroblastoma metastases, you do not have to wait for them to grow larger, and then resort to emergency surgery. There have been reports (Polin et al, 1998 and Sheehan et al, 2000) that show benefit in using preliminary chemotherapy or radiation therapy prior to surgery in the setting of recurrent disease. The chemo-radiation serves to shrink the metastatic lesions so that the subsequent surgery is less extensive and less morbid. The efficacy of this treatment approach, however, has not been tested in large scale clinical trials, due to the relative rarity of olfactory neuroblastoma cases. If those tumors are primary brain tumors, treatment would still depend on the histologic subtype. For the most common primary brain tumor – astrocytoma – treatment of multiple lesions would consist of re-excision of the tumors (if still resectable), followed by a course of chemotherapy (example: temozolomide) and radiation therapy. Again, there is no need to wait for the tumors to grow before doing surgery, unless there is a contraindication to doing surgery sooner (e.g. there are other medical conditions which need to be treated first prior to the operation).

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