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Next Steps in Treatment

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It’s been awhile since I shared a status update on things. Here’s the latest.

After meeting with the Robert Cavaliere of The James Cancer Hospital at Ohio State, he laid out a few different things to consider:

  • At 47, I’m a bit older than the median age for people who get gliomas. The older you are, the worse your prognosis and the more aggressive you typically want to be with treatment.
  • My tumor has certain genetic markers (1p/19q deletion and IDH positive) that research has shown make treatment more effective.
  • Even though my tumor is considered a grade 2 tumor, there’s more of a spectrum to tumor severity than the discrete grades of 1, 2, 3, and 4 implies. Gliomas can (and frequently do) increase in grade over time. And there were things in the pathology for mine that indicated it was early in the process of trying to move from a 2 to a 3.
  • If we chose to do nothing but observation, I would very likely be looking at my tumor recurring sooner rather than later. Recent research suggests that this would portend lower overall survivability. While that may seem obvious, it has not always been so clear.
  • Other recent research makes it pretty clear that early treatments including both chemotherapy and radiation have better results than radiation only approaches. There has been little research done yet on chemotherapy only as an early treatment approach.

Given all of that, he said we had three rational choices that he could support.

  1. We could wait until the tumor recurred and then move into a chemo/radiation treatment at that time.
  2. We could get aggressive now and start right away with both chemotherapy and radiation.
  3. We could get aggressive and try “the road less traveled” and do chemotherapy only, saving radiation for when the tumor recurs.

I’m someone who’s much more comfortable being proactive than waiting, so that ruled out the first. Given that there was more research with the second than the third, that’s what I have chosen.

This morning, I had a planning visit with the radiation oncologist. I got another MRI done and was fitted for a mask that I’ll wear during the treatments.  The mask’s job is to keep me absolutely still during the radiation treatment. I had to lie still for 30 minutes today while the mask dried. It was pretty difficult, but I now have options for what to wear at Halloween.

My radiation treatments will begin on or about July 21. I’ll have them 5 days a week for six weeks. Each treatment will be relatively short – less than a half hour appointment of which the radiation zapping itself is only a couple minutes total.

At the same time, I’m going to start a course of chemotherapy. This involves taking a Temodar pill along with anti-nausea and antibiotic pills in the evening. It will be an everyday thing during the course of the radiation treatment. After that, I get a month break and then move into a mode where I go through 6-12 monthly cycles of 5 days on, 23 days off with the Temodar.

My understanding is that most people tolerate both the radiation treatments and the chemo pretty well. I’m not expecting to have my work affected beyond the simple fact that I won’t be able to travel for at least six weeks while doing radiation.

I still feel very fortunate for how well things have gone so far. Love and prayers from all of you are no doubt a big part of why that’s been so. Thanks so much for your continued thoughts.

Written by mdoel

July 10, 2014 at 6:25 pm

Posted in Uncategorized

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