Saturday, November 5, 2011

Friday, November 4, 2011

We met with Dr. Comito this afternoon to further discuss yesterday's meeting with Dr. Dunkel as well as some other options she wanted to offer us after speaking with some other pediatric oncologists around the country.

As I mentioned in my last update, in order for the various treatment options to have the best chance of success, the first step is to get rid of as much tumor as possible. One way to accomplish this is another resection surgery. There are risks with another brain surgery, and we will be meeting with Collin's neurosurgeon Monday to discuss these risks. Dr. Comito offered us another option to consider, and that is doing another round or two of chemo first. After the first two rounds of chemo last year, most or all of Collin's measurable disease was gone. And as rough as chemo was, Collin's body still handled it fairly well. By doing a round or two of chemo first, there is the chance that it could shrink or kill the current tumor, and then another brain surgery could be avoided. There are risks with chemo as well, and Collin would lose his hair again and probably end up hospitalized with a neutropenic fever at some point, but when we compare how Collin fared with chemo versus how he fared with brain surgery, chemo seems less risky than brain surgery. It is the brain surgery that left him with right sided weakness, the problems with his eyes, the facial paralysis, and the difficulty communicating. Trying chemo first could hopefully eliminate the need for another brain surgery, and also buy us a little more time to put into place the plans and arrangements for radiation.

Radiation is based on the idea of selective cell destruction, and uses energy to destroy cells. There are two different kinds of external beam radiation that can be used on Collin. Traditional radiation uses high-energy radiation, usually from X-rays, to kill cancer cells and shrink tumors. The problem with X-rays is that they're not easy to control. As X-ray enters the body, it gives off  a tremendous amount of energy at the point of entry. As long as the tumor is somewhere in the path of the X-ray, it receives some of that radiation. But so does the healthy tissue around it. The X-ray has an entry point and an exit point through the body. Proton beam radiation can cause less collateral damage to surrounding healthy tissue. The proton beams are easier to control than X-rays, and can be set to release their energy at a specific point in the body. The proton beam has an entry point, but since the radiation can be set to stop at the tumor, there is no exit point like there is with X-ray. Radiation would be given daily, under anesthesia, over a number of weeks. Traditional radiation could be done at Hershey Medical Center; proton beam radiation would have to be done at one of the few proton beam centers in the country. 

Some of the side effects of radiation to the brain and spine include skin changes, fatigue, nausea, vomiting, hair loss, eating and digestion problems, hormonal imbalances, hearing loss, organ damage, stunted growth of the spine, stroke, IQ and memory deficits, and secondary cancers. Some of the side effects are temporary, and others are permanent or may occur years after radiation treatment. Higher doses of radiation most likely have more severe side effects. Some of the decisions we still have to make are the dose of radiation to give, and in the case of proton beam radiation, where in the country to get it.

We are looking forward to a fun weekend visiting with and getting to know more of our extended Altoona THON family. We certainly need some fun! Monday will be another busy day with therapy, picking up the orthotics for Collin's feet, and meeting with the neurosurgeon. 

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