Rough Weekend

Dehydration Monday

　

Michele had an uncomfortable weekend after Friday’s first chemotherapy treatment with Carboplatin.

She experienced gastrointestinal toxicity--vomiting and nausea--which is common (65% occurrence) for Carboplatin.

She was also in bed from Friday afternoon until Monday morning, when we went back to the doctor’s office for an unscheduled office visit and a rehydration infusion. We also got some meds to combat the side effects.

Carboplatin is pretty powerful stuff. It is no wonder that it is only administered once every four weeks. The doc says that the worst is over and that Michele should be feeling better every day, but he still wants to see her again on Friday.

RKS

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Can Do

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Yes We Can

Friday 20 August 2010

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As expected, the peer committee endorsed the proposed treatment plan. The next MRI is scheduled for Thursday 16 September--in four weeks. We should get the results on Friday and plan to post the results late Saturday.

If the results are good, we will continue the treatment plan. If the results are bad, we are running out of options.

On a sad note, Michele’s French chemo buddy died yesterday.

RKS

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Better News

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Better News

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Michele and I visited with our surgeon, Kit Fox, and oncologist, Punit Chadha Monday afternoon.

Dr Fox showed us side by side comparisons of the May and August MRI’s. There are actually two areas of concern.

On some MRI slices (or views), the small “enhancement” in the previous cancer location does not appear to have changed significantly. Dr Fox does not believe that this enhancement should be a major concern right now, but of course bears watching. He says that it is far outside the critical “eloquent” or “word area” of the brain. ( Dr Fox seems to define “far” as over a half inch or a centimeter in distance. ) He believes that in its present size and location, removal would be a much easier surgery than either of the surgeries he performed on Michele last year. He does not see any need for immediate surgery.

The other area of concern is completely outside of the original cancer area, perhaps over an inch or about three centimeters in front of the original site. It is closer to Michele’s left eye and is in the “frontal area“ of her brain. It is common for GBM cancer to reappear in different areas of the brain.

The area of “enhancement” is very small--pea sized--5mm by 7mm. It is not in a critical area of the brain and is on the surface, just beneath the skull. If you were a highly skilled (but somewhat flippant) brain surgeon, you might say that it doesn’t get any easier. He does not see any need for immediate surgery and thinks that we should consider all our treatment options before having a third surgery in the same general area of the brain. Some surgical risks are cumulative.


Drs Fox and Chadha will decide on a treatment plan Friday morning during a peer review meeting. We expect the following treatment plan to be endorsed by the committee:

1. Stop CPT-11 and start Carboplatin this Friday, 20 August and plan to continue on a four week cycle.
2. Continue Avastin, but on a two week cycle, beginning on 20 August.
3. Rest (no treatment) on alternate weeks.
4. Have another MRI in September. (Five weeks would be 16 Sep.)
5. Re-evaluate the situation in September.

RKS

Bad MRI

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Friday the Thirteenth--Bad Luck
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We received the results of Thursday’s MRI Friday morning. The news was not good.

The radiologist found a small “enhancement” in the previous cancer location. This is most likely a recurrence of GBM cancer. There is a very slight possibility that it could be latent damage caused by the radiation treatment from early last year. The only way to tell for certain is to surgically remove the growth and have it examined by a pathologist.

We have an appointment with Dr Kit Fox Monday afternoon to have a surgery risk evaluation. Michele has had so much of the eloquent area of her brain removed that she is having great difficulty now with anything having to do with words (reading, speaking, listening, and remembering names) that we wonder how much more of her brain can we afford to have removed.

A third surgery could be as early as next week but is more likely next month.

If we do not have immediate surgery, we will change the chemotherapy mix and switch from CPT-11 to carboplatin, while continuing Avastin. Carboplatin (Paraplatin) is one of the older chemo drugs--it was first approved for cancer treatment in 1989.

Our main concern with carboplatin is that it causes the blood cell and platelet output of bone marrow in the body to decrease dramatically, sometimes as low as 10% of its usual production levels. This decrease in white blood cells ( neutropenia ) will cause a increased probability of infection, which may require hospitalization for treatment with strong antibiotics. .

　

Our most probable course will be to:

1. See Dr Fox Monday afternoon.

2. Stop CPT-11 and start Carboplatin.

3. Have another MRI in late September. (Six weeks would be 23 Sep.)

4. Re-evaluate the situation.

5. A third surgery the last week of September.

　

Best,

RKS