Radiation with or without Temodar for Glioblastoma?
I am a 3rd year medical student & the daughter of a father recently diagnosed with Glioblastoma. He has also been battling leukemia (Chronic Lymphocytic Leukemia – CLL) for the past 13 years. Here's a quick summary of events so far leading up to my question:
April 7, 2020 – Visit to the local emergency department given symptoms of high BP (170/90s), nausea, headache, fatigue & what appeared to be incoordination. Worried it was a stroke or brain bleed given a fall the previous night so urged dad to go to ED. All reports (EKG, BP, etc.) were clear but MRI showed incidental finding of a contrast-enhancing brain tumor in the RIGHT parieto-occipital region (~2.1 cm in size) and an area (~3 cm) of signal irregularity in the RIGHT frontal gyrus (no contrast enhancement evident) along with some edema/inflammation around both sites.
April 7 – April 9, 2020 – observed overnight at the hospital for 2 nights – placed on steroids (Dexamethasone) and anti-seizure med (Keppra). Decision to pursue surgery to remove mass & biopsy to figure out what it is. **However**, the leukemia medication he is on called Ibrutinib acts as a blood-thinner so surgery was postponed for 14 days while holding that medication.
April 23, 2020 – underwent craniotomy to remove RIGHT parieto-occipital mass
Today (May 10, 2020) – recovering 2 weeks post surgery. Experiencing fatigue, intermittent indigestion/nausea/constipation issues, and headache. Has been tapered off the steroid (Dexamethasone) & has not taken any for the past week. Continuing anti-seizure med (Keppra) and his usual meds for CLL, fenofibrate, vitamins, etc.
We consulted with neuro-oncology & radiation oncology this past week – got the initial radiation simulation/MRI planning done. They suggested proceeding with radiation treatment (traditional radiation – NOT proton therapy) for both areas on the brain (the area where the RIGHT partieto-occipital tumor was removed from & the stable area on the RIGHT frontal lobe). However, given the COVID19 situation & the fact that he is already immunocompromised given the CLL & the drug he is on for that (Ibrutinib), neuro-onc suggested 6 weeks of radiation WITHOUT temodar. With the plan of perhaps doing Temodar later post radiation. What are your thoughts on this for those of you who have had radiation +/- Temodar? How effective is the radiation vs. Temodar? Does not giving him Temodar concurrently with the radiation serve as a disadvantage in terms of outcomes?