Good News/ What’s Working

I’ve been overwhelmed by procedures and pending decisions and information by a multiplicity of sources in the new(to me) and strange area of radiology for the past month. Comments from several of the docs involved are: “The stereotactic radiotherapy (Stereotactic Body Radiation Therapy–SBRT) for you has a very good chance of getting some result, is very unlikely to cure it, it may however more or less permanently control it.” “I don’t know if the damaged liver lobe will regrow after radiation as it would after surgery.” “The main side effect of your SBRT is fatigue lasting from one week to one month.” “You won’t be considered for adjuvant follow-up chemotherapy for two months after the end of your stereotactic radiotherapy treatment.” “After treatment, there is a 60-70% chance that the cholangio tumor will NOT grow back at the exact same spot.” “The SBRT WILL likely stop all visible cancer in the tumor, which means that the tumor will likely stay where it is, but will NOT grow forward.” “Although there is a 60-70% chance that the cholangio tumor will not grow back at the exact same spot, statistically there is also a 60-70% chance that metastases WILL grow elsewhere with ICC patients.”

There’s been a good bit of information to collect and digest. Next week, I see my chemo onc again and will inquire of his opinions about recommensing chemotherapy in place of radiation or following radiation. The radiology onc said there would be no adjuvant radiation to the exact same tumor location since I would be getting the highest allowable dose with the scheduled SBRT. Subsequent surgery is extremely unlikely due to marked scarring from radiation. Radioembolization with microspheres has been ruled out, as well. SO, my choices of traditional treatment are narrowing.

My choices of treatment are also narrowing by law, since I have now completed the transition from Blue Cross/ Blue Shield to Missouri Medicaid–which limits my choices to treatments and doctors to those practicing in the State of Missouri. (Ain’t health care reform grand? But seriously folks…..).

The GOOD news for me is that CT scan results from 8/10/2010 indicate that the measure of my tumor reveals still-continuing shrinkage from 5.6 cm AP X 6.2 cm transverse on 6/17/2010 down to 5.4 cm AP X 5.0 cm transverse. It seems to be a little over half as big as it was when chemotherapy was started in early March this year. The other GOOD news is that the CT report said that there is still “NO CT evidence of metastatic disease.(!!!)” Thank God, nutritional supplementation, and chemotherapy!!

So, having passed through the CT scan hurdle, my old body appears to have qualified for the SBRT clinical trial. The radiation treatments, each lasting about an hour, are scheduled for the last week in August and the first week in September, and there are five of them.

The OTHER GOOD news for anyone qualified and interested is that my radiation oncologist at the Siteman Cancer Center/Washington University and Barnes/Jewish Hospital of St. Louis is seeking calls from those qualified and interested in participating in his SBRT clinical trials. I am emailing Marions with details, but he said he ONLY wants prescreened calls from those whose cancers have been determined to be non-resectable, preferably having been treated with the standard chemotherapy regiment for ICC or HCC, and with absolutely no metastases or lymph node involvement.

To all: On July 27, I went in to the Siteman Cancer Center at Barnes/Jewish hospital of St. Louis, MO for an arteriogram/mapping session to inspect the routing for my planned radioembolization on August 11. The mapping session was ended early when the docs found that the tumor-blocked blood supply to the left lobe of the liver had caused the arteries/veins to atrophy beyond the point where they would allow safe passage and planting of the microspheres for successful intervention. The doc in charge said there were still treatment options which, although less ideal than radioembolization, would offer hope for shrinking/killing the tumor.

Today, July 30, 2010, I received a call from the chief Interventional Radiologist, who discussed Siteman’s next proposed course of treatment. He proposes to use their stereotactic equipment for stereotactic radiotherapy/radiosurgery. This involves 5 sessions (over two weeks) of external radiation aimed at the tumor from a variety of different angles so that the radiation received by the tumor will be much greater than that received by surrounding tissues encountered by the radiation beams en route to the tumor. Few side effects are to be expected, possibly including some heartburn and mild queasiness/nausea–and I should be able to drive myself to and from the sessions.

They have a triplex (?) unit that includes three different treatment devices, according to the Siteman website–I think they’ll be using the basic stereotactic part on me. The good news is that over a period of a few months after the radiation, it should become apparent to what extent the treatment is successful. The disadvantage of this procedure over the originally-planned radioembolization/microspheres is that the stereotactic procedure only gets the cancer that is visible on the imaging devices, whereas the radioembolization/microspheres would have penetrated more deeply into the liver to get at cancer that might not show up on the images. The other disadvantage (?) is that the stereotactic radiation is considered only as a replacement for surgery in my case. According to the Interventional Radiologist, the aftereffects of the radiation include scarring of tissues which will render surgery impossible.

Overall, it seems that the sterotactic radiation therapy edges more toward the palliative than the curative treatment that I’d hung my hopes on, but if successful, it should buy me more time and perhaps, after follow-up chemotherapy, a return to work.

Well. there’s my “show and tell” for the week, and what a week it has been. Severe disappointment on Tuesday turned to less-than-ecstasy for Friday evening, but with a sincere “Thank God” for a treatment option with continued hope. A good weekend to any and all interested parties.

Thanks for the award, Lainy!! Not only did you figure out the award I was fishing for, but you made me laugh, and that always merits an award right back at you. God bless you both! And yes, you’ve an open invitation to the Grand Opening!