Possible Tumor Recurrence

[Dawg05]

My husband was just told by a neurosurgeon that his brain tumor from 21 years ago (he had one when he was only 7) has grown back.  He had a grade II cerebellar astrocytoma that was mostly removed with surgery and then he had radiation therapy.  After the radiation therapy, the tumor was completely gone.  Then six years ago, an area of abnormality showed up on an MRI in the same location of the previous tumor.  They said that it was due to surgical defects from the previous resection.  He continued to have MRI's about every year and they all said the abnormality was either encephalomalacia, gliosis, or that it was from the radiation therapy.  But just 1 month ago, an MRI showed that the mass had grown and is now putting pressure on the 4th ventricle so the surgeon said the only thing to do is take it out.  I am just wondering why ALL of the radiologists who performed the MRI's always said in their impressions that--no recurrent tumor is identified--when the surgeon looks right at us and says--your tumor is back?  Is it okay to have a second crainiotomy?  And is it okay to have radiation again if you had it 20 years before?  We are scheduled for the surgery but any answers would be great!  Thanks!

[CCF-Neuro-M.D.-PW]

grade 2 astrocytomas are slow growing but also are infiltrative (they spread out into normal tissue) and can be diffuse (spread over a large area). We can only see down to a certain resolution on MRI so a complete removal of a MRI visible area does not necessarily mean that all the tumor cells have been removed. Hence further treatment with, for example, radiotherapy. But there is a chance that tumor cells remain. 21 years is a long time though for the cells to remain 'dormant'

A potential risk of radiation is the development of a 'secondary malignancy' related to the radiation itself, and this can occur this length of time after treatment - so it may not be an astrocytoma, it may be something else, possibly a meningioma - I cannot be more specific

It can be hard to tell a small amount of postsurgical change from tunmor unless there is change or growth over time.

It is ok to have a second craniotomy, although scar tissue underneath can make further surgery more difficult. A biopsy diagnosis of the current tumor is essential to plan treatment. The amount of radiotherapy that can be given is dependent on the total dose of radiation. However nowadays technology has improved and very focused beams of radiation can be given to a few cm of tissue (gamma knife)

Good luck

[Christie2004]

I wonder about that, too.

Years ago, I had an MRI for a suspected disc herniation.  Radiologist said no hernia at L5-S1, but minor bulging at another site.
Still having the pain, so I brought THOSE MRI films to a neurosurgeon, who saw the herniation in about 2 seconds.  A big one.
Had surgery and was eventually ok.

So sometimes I wonder about radiologists interpretations of MRI's.  I'm getting another one next week for headaches, and you can bet I'm taking the films to the neuro guy to review.

Good luck, and I wish you well with your situation.