Old Hat, New Techniques

22 Nov

As you all have read in the previous posting, we were recommended by our Neuro Oncologist at MD Anderson to treat the recurrence as a new tumor.  So, this week was going in and getting ready for starting Radiation and Chemotherapy Treatments.  Well, I must say that a lot has changed in fourteen years.  A few observations/ changes that I’ve noticed are:

  • Gone are the days were standard treatment is one treatment followed by another.  We’ve learned that they see a benefit from giving a low dose of chemo (7 days/ week) while doing radiation treatment.
  • While chemo is still unsavory, at least it is not as toxic as it used to be.  The chemo that Susie will take (Temozolomide/ Temodar) is the same they were testing 14 years ago, but it is now the defacto for brain cancer treatment and doing the toxic intravenous ones did not show terrific results.
  • The CT Scanning machines are lightening fast.  I mean WAY faster than your traditional scanner at home.
  • Radiation is now done real-time with the CT Imaging.  No more paper plans on graph paper.

The above being said, this next phase is not a walk in the park.  As Susie is getting a second round of radiation, albeit 14 years later, there is a risk of radiation necrosis.  Also the chemotherapy drug is likely to cause nausea (Zofran is our friend), constipation and low platelets.  It is the last item, low platelet counts (also known as thrombocytopenia), that we will need to be most careful and diligent in our monitoring.  The reason is having low platelets can result in internal bleeding.  Therefore, Susie will be having her blood drawn every Thursday during treatment.  If her blood platelet count is below a specific threshold, then we will test daily and make a decision whether a transfusion is necessary.  Unfortunately, there is no shot for thrombocytopenia.

Nevertheless, the plan forward is different than what we did fourteen years ago.  It is basically broken into the three following phases:

PHASE 1 (6 Weeks – Combined Therapy)

  • Radiation Monday through Friday, starting 25-NOV
  • Temodar 7 days per week at bedtime, starting 24-NOV
  • Zofran (anti-nausea) and Dapsone (antibiotic) 30 minutes before Temodar
  • Blood Tests every week, Checkpoint after 3 weeks

PHASE 2 (3 Weeks – Recovery)

  • No Radiation or Chemo
  • MRI and Checkpoint after 3 weeks rest/ recovery

PHASE 3 (12 Months – Maintenance Therapy)

  • 12 cycles of Temodar, once a month for 5 days
  • Blood tests on Day 1 and Day 22 of each cycle
  • Continue Zofran as in Phase 1, No Dapsone
  • MRI every two months

While we had a good idea what we were about to embark on, the techniques and procedures have clearly changed.  Nevertheless, we greatly like our doctors and are hoping for the best outcome.