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).
