Ask doctor Landolfi

   
A nice feature of our group is that we ask questions to Dr. Landolfi weekly, and he answers them in easy to understand language. We thank him for this generous donation of time and expertise! He certainly helps us make sense out of this confusing diagnosis.
 
 
Disclaimer: The following answers express the opinion of Dr. Landolfi and should not be used as a substitution for seeking medical attention for any personal problem.
 
  We see on a fairly consistent basis where a biopsy is performed to initially determine tumor type and grade.Why not just debulk the tumor while already in there? What are your thoughts on why some doctors perform biopsies before a surgery?
 
Thank you, Dr. Landolfi;
Bruce
 
The only reason to biopsy a resectable lesion is if lymphoma is in the differential, which a not resected because of the remarkable response to chemo and radiotherapy. We do open biopsies, where we go into surgery with the idea of resecting the lesion, send tissue down to the pathologist and if it a resectable lesion, remove it at that time. The practice of biopsy and then later resection increases the risks to the patient as they are now undergoing two procedures(and anesthesia) rather than one. I think it is a poor practice. Dr. Landolfi
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Hello again, Dr. Landolfi;
 
     This weeks question has to do with post treatment depression. Is it a physical reaction, or is it a post traumatic reaction?
     Understandably, almost all of our members have experienced depression after treatment.
 
As always, Thank you!
Bruce
 
depression is multifactorial. it probably relates to the diagnosis, medications, reaction to illness. there may also be a structural component in some patients depending on location of the lesion(ie. frontal).dr. landolfi
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Hello again, Dr. Landolfi;
     Here is another question, one day late....
 
     One of the biggest decisions a person has to make when they are diagnosed with a tumor is where to have the operation performed. What factors should be used in choosing a hospital and medical team? 
 
As always - Thank You!
Bruce
 
Choose a hospital that has a team dedicated to treating  brain and spinal cord tumors.  The places with such dedicated teams are most likely to have the most experience.  These places are also most likely to have the necessary equipment to perform the surgery safely Always ask about their own experience with regards to complication rate is such a stroke, infection, and death.  Dr. Landolfi
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Hello again dr. Landolfi;
     Here is another question from the group:
 
     Many of us are left with debilitation pain after removal of tumors - specifically to the spine. In many cases, traditional pain treatments are less than effective. Are there any new techniques that might provide relief to these folks?
 
Thank you!
Bruce
 
Typically, physical therapy, occupational therapy, acupuncture, acupressure, and medications are used.  Spinal cord stimulation and intrathecal narcotic pumps (where pain medications are directly delivered into the area surrounding the spinal cord) are newer devices that are used.  Most patients can be treated adequately with medications at the appropriate medications are chosen for the type of pain the patient may experience.  For example burning type pain may respond very well to antidepressant medications like Elavil.  Another type of pain cold radicular pain, which cause a sharp shooting pain down the spine, may be better treated by anticonvulsants.  Very few patients have to go to spinal cord stimulation or spinal cord comp, but they are used.  Depending on the type of pain, deep brain stimulation to the thalamus may also be used.
Dr. Landolfi
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Hello again;
     Just recently, I have heard of neuro-psychologists and neuro-optometrists - among others that could benefit someone who has been diagnosed with a brain tumor. What would you suggest to be a possible course of treatment for such a person?
As always - Thanks!
Bruce
 
i think an overall good rehabilitation program would benefit most if not all post op patients. this would include the specialists you listed. good dental care for patients who receive radiotherapy to an area that could effect the teeth would also be wise. dr. landolfi
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Hello again, Dr. Landolfi;
     I have another question for you:
 
     In a recent study that was published in the "Journal of Neurosurgery" - Spine (6-2007), Cyclooxygenase - 2 expression in ependymoma of the spinal cord concludes that certain selective Cox - 2 inhibitors could be useful in treating both spinal and cranial ependymomas. Do you feel there is a potential therapeutic benefit to this drug? Do you feel that any benefit outweighs the drawbacks?
 
     Thank you - (as always)
Bruce
 
this relationship is not limited to ependymomas.If patients need to be on an anti-inflammatory drug indefinitely, i choose a cox-2 becuase of the theoretical benefit. nothing has been proven with regard to response.  if you need it for other reasons, it is a resonable thing to do-in that case the benefits outweigh the risks. it is a dicusssion that should take place between the treating physician and patient. dr. Landolfi
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Hi again, Dr. Landolfi

 

     This week we have another question. Some Chemotherapy drugs (e.g. the platins) cause nerve damage as a side effect. On average, does the body repair this nerve damage, and if so - to what extent?

 

Thank you, as always!

Bruce

Most of the time the neuropathy caused by vincristine is reversible with the cessation of the drug. Rarely it may be permanent. If neuropathy does occur while on a platin, it may be permanent with little to no improvement. If it is caught early and chemo can be stopped, it may be reversible. This is not always possible.dr. landolfi

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Hi again;
 
     After tumor surgery, some of us developed blood clots, and were treated with either medicinal blood thinners, or were implanted with Greenfield filters. We have heard that cancer is a "coagulative" disease. What does this mean, and why?
 
    Thank you Dr. Landolfi, for your continued assistance to our group!
 
Bruce
 
people with cancer are more likely to develop clots. this is what hypercoaguable means. they exact mechanism is unknown. some believe the cancer release a factor that affect the liver cascade of enzymes and proteins that regulate how thin the blood is. dr. landolfi
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Hello again, Dr. Landolfi;

     Here is the latest thing we have been wondering about...

 

     Some of us are taking the exact same chemotherapy drug for the exact same disease, yet the dosage and scheduling is very different. It is understood that all patients are physically different, but why are the treatment plans so extremely varied?

     Thanks - as always!

Bruce, 4th ventricle surgery & radiation, '95

The dose is based on height and weight calculated as a body surface area. Some chemo is based on weight alone. Depending on physical and blood work doses may be further adjusted. Dr. landolfi

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  Hello again;

     Here's another one!

 

Could you tell us-

 

     What research is being done with stem cells to regenerate nerves that were damaged because of surgery and radiation?

 

Thank you, Dr. Landolfi

 

Bruce

 

Most research being done with stem cells is being done in cases of spinal cord injury. If successful, certainly other areas can be looked at. We do now have evidence that even brain neurons are capable of repair, but this research is in it’s infancy. I will be away next week. As always, best regards, dr. landolfi

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Hello Dr. Landolfi;

     Here is another question -

 

     I have heard that chemotherapy is less effective on ependymomas than other types of tumors. Is this correct, and if so - why?

 

Thanks - Bruce

 

Yes. This is true. The reason is not clear. Several chemotherapies have been attempted but the results were disappointing.

     ~
Hello again, Dr Landolfi;
 
     Here is another one we have been wondering about:
 
     Historically, radiation treatment for subependymomas has been less effective than for other types of brain tumors, and even other types of ependymomas. Given this and the potential for damaging side effects, in your opinion - should it ever be prescribed for subependymoma treatment?
 
As always - Thanks!
Bruce
 
if the subependymoma is behaving aggressively or recurs and surgery is not an option, radiation should be attempted.
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Hello again, Dr. Landolfi;

 

     Have you ever heard of or do you have any experience with Noni Juice? We have heard claims that it will take away the tumor and remove fatigue. What is your opinion?

 

Thanks!

Bruce

I only had one patient use it. It helped their fatigue. It does nothing for the tumor. I don’t know a lot about it. Dr.landolfi

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Hello again, Dr. Landolfi;

 

     Another question...

 

     Some people just seem to "grow" tumors more than others. Other than metastatic tumors, are there any links between specific types of tumors and a tendency to have benign tumors elsewhere?

 

Thank you, as always.

 

Bruce

There are several familial syndromes that can have multiple benign or a mixture of benign and malignant tumors. They usually involve tumors in the body and in the brain. I am not referring to metastatic tumors. For example there is a syndrome known as Turcot syndrome (colon polyps and brain tumors). Other syndromes involve only brain tumors like neurofibromatosis (multiple benign and malignant tumors). There are other syndromes known as MEN syndromes which involve multiple endocrine neoplasms which can involve the pituitary, thyroid, breast adrenal or pancreas. Current research is underway to determine if there is genetic susceptibility in brain tumor patients in general. Dr. landolfi

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Hello again;
     This weeks question is about the importance of a patient having a positive attitude. How important do you feel it is, and is there any medical benefit from such an attitude?
 
Thank you,
Bruce
 
i find it to be extremely important. there was a paper published years ago(i don't remember the reference) showing that patients with positive attitude did better than those who did not. Thare was another study that showed patients who were prayed for (and they did not know they were being prayed for) did better than those who were not prayed for.in any case, i feel positive attitude goes along way, including with regard to tolerabilty of treatment. Dr. Landolfi
 
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