Patient Question:Disease:Treatment options for recurrence after grade IV glioma Description:Hello, Director Lin. I am the son of patient Bai×× and would like to consult with you about treatment options for recurrence. My father was operated on by you in April 2012 for a grade 4 glioma, after which he underwent conventional radiotherapy, and started taking 3 courses of Tadalafil in April 2013, but stopped because his white blood cells did not rise. In January 2014, the MRI showed signs of recurrence, and at the end of February, the MRI was similar to that of January, but showed signs of enlargement; in early March, PET-MRI methionine metabolism was done, and the recurrence was confirmed near the brainstem. The patient has now been bedridden for 4 months and is incontinent with symptoms of dysphagia. You do not recommend further surgery and may consider radio-wave knife combined with chemotherapy. I would like to consult you about the possible sequelae of radiation therapy, such as cerebral edema and increased cranial pressure, which may be more serious than the first one, if I have a second radiation therapy with radio-wave knife. I am worried that it may cause coma or vision loss or even blindness, and the patient’s quality of life may be worse than now. Can we first skip the radiofrequency knife and treat with the targeted therapy drug bevacizumab, which can be considered in combination with temozolomide or irinotecan? Because of the high expression of VEGF(++++) and EGFR(++++) of the tumor in the pathological test after the initial surgery, and the brain edema is more obvious after radiotherapy, treatment with targeted therapy should be more effective. I wonder if such a treatment plan is feasible? If so, can I receive targeted therapy from you? Thank you very much, Director Lin, for your kind treatment and guidance in the past 2 years, but our battle still needs to continue. Hospital Department Visited:Tiantan Hospital Neurosurgery Treatment:Time:2012-05-01 2013-02-10 Hospital Department:Tiantan Hospital Neurosurgery Treatment Process:Last April, the left temporal lobe of the brain surgery, 30 times post-operative radiotherapy, chemotherapy 6 courses Beijing Tiantan Hospital Neurosurgery Lin Song Reply: You can family members to bring films to see. Patient Question: Good New Year, Director Lin! I am the son of your old patient Bai Xihe, and last month I registered a specialist to see you for the latest films and treatment advice. Unfortunately, my father passed away yesterday, February 7, 2016 at noon, mainly due to pneumonia, with a high fever of 40 degrees for almost 5 days, and organ failure throughout his body. I wanted to bring him to you for further treatment when he was better, but it did not work out as planned. Looking back, it has been almost 4 years since you removed the yeast cell tumor grade 4 in April 2012 until yesterday, and I have experienced pain and despair as well as hope and confidence. Thank you very much for your guidance and treatment of my father’s condition during these years. I would like to say thank you from the bottom of my heart. I hope you will take care of your health and continue to provide excellent medical treatment to more and more brain tumor patients, and bring hope to more and more patients and their families. Thank you! Reply from the Department of Neurosurgery, Beijing Tiantan Hospital: Your father unfortunately suffered from a highly malignant glioblastoma, but fortunately, thanks to the tireless efforts of your family and the patient, the patient survived several times longer than the average for this disease. My condolences! I will also continue to work hard to improve my practice as you wish, and strive to provide a higher level of service to my patients.