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

Next MRI -- 12 August

Dr Chada has scheduled Michele's next MRI for Thursday, 12 August. He has decided that Michele is responding to treatment well and has extended the MRI interval from nine to twelve weeks. We expect to get the results on Friday the thirteenth and will post the results on Sunday.



RKS

Five in a Row

Thursday's MRI indicated no change from the March MRI -- no evidence of cancer or anything new and abnormal. No evidence of recurrence is visible.

RKS

Four in a Row

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Michele’s Luck Continues after St Patrick’s Day.

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Same as before, the MRI shows no sign of cancer.

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Even though Michele may not have a single Irish gene, her luck continues. We had originally scheduled her MRI this week for Wednesday, St. Patrick’s Day (since we Schultz’s are so Irish). However, Michele could not stand the thought of waiting two days for the results, so she rescheduled the MRI for Thursday, allowing us to get the results during her doctor’s appointment on Friday. The doctor insisted upon discussing the results face to face.

Michele’s second surgery was way back on 23 July 2009 and she is now in her eleventh three-week cycle of Avastin and CPT-11. Since it seems to be working, we plan to continue that protocol for as long as it works.

On this MRI especially, we were not expecting such good results. We had two major concerns this month.

Michele’s memory and communication skills have continued to deteriorate. In the past month, she has experienced increased difficulty in speaking and has had extreme difficulty remembering names -- even the names of relatives and close friends. The cancer was located in the eloquent (Broca’s area -- word processing speaking, word selection, word memory) portion of the brain. Back in February 2009, the first sign of trouble was difficulty in speaking and reading. A tumor recurrence in that area could be causing these current problems.

Our second concern was Michele’s “wobbliness.” Mobility has been difficult because she has had serious problems with balance and coordination. In the past month, she has experienced several very painful falls. No bones have broken, but she has some huge bruises. A completely different portion of the brain, the cerebellum, is responsible for the body's balance, posture, and the coordination of movement. If the cerebellum was now cancerous, we would be in real trouble.

Although no cancer was observed in either area, or anywhere else in Michele’s brain, considerable shrinkage of the eloquent area was observed. The doctor believes that this new shrinkage may be the result of the radiation treatment received last spring -- many brain cells were damaged by the radiation and only now are withering. Regeneration of the area will not happen. A study was published last year suggesting that speech functions can shift to nearby areas in the brain.

. [ Plaza M, Gatignol P, Leroy M, Duffau H. (2009). Speaking without Broca's area after tumor resection. Neurocase.9:1-17. PMID 19274574 http://www.ncbi.nlm.nih.gov/pubmed/19274574 ] . ..

Exercising the brain may help develop undamaged areas. We are beginning to work on this.

No explanation was given for Michele’s mobility and balance problems.

In summary, we are alive without visible brain cancer, which is an accomplishment, but continue to have serious language and mobility problems.

We expect the next MRI in nine weeks -- o/a Thursday 20 May.

Next posting expected o/a 22 May.

RKS