deja vu

Mark had the functional mri and brain lab mri scans last Friday.  Today we met with Dr. Liau to review the results. The mapping scan shows that the new area is just in front of resection of the old spot.  In the test they mapped the language, motor and sensory areas.  The new tumor does go into sensory area of hand, and Dr. Liau was really surprised that Mark wasn't already showing any symptoms of numbness on  his right hand? She suspects that other parts of his brain may be compensating.  The mapping showed that the new tumor doesn't seem to be too close to the comprehension or language areas.  She said she can surgically remove the tumor, but there is risk of numbness in his hand and possibly weakness. Surgery is a good option because then we'll be able to get it out to help slow down growth, we'd know what it was (scar vs tumor) and would have tissue. There are recurrent trials that can use tissue if we take it out and there is also a gene therapy trial Mark could be eligible for.  Because it has been long enough, radiation can still happen after surgery if needed or instead of surgery.  Some swelling does show in the scans so it will be good to make a decision before it affects in other ways.  Most likely it is tumor instead of scar tissue because of the length of time it has been since the original surgery. A biopsy to find out would be just as risky, so it is better to go for surgery.  This time surgery would be done while Mark was awake. She could also go through the same incision and even smooth out the scar some!  Mark is opting for surgery.  We have a language eval scheduled  on 2/24 @ 11am and surgery will be  3/5.  We still need to schedule the primary doc for surgery clearance (ekg etc) and are getting a blood test today.  We had to sign a lot of papers, but looks like we'll be headed to surgery early next month!

researching the next steps

We again went to see Dr. Peter Chen - Mark's radio oncologist
He checked out Mark and said all his body functions looked good and his tumor wasr emarkably localized.  He said Mark is a great candidate for radiation again.  He said that there is less risk of a swelling reaction since his body has recovered from the previous radiation treatment for years.  He mentioned that they have had good results with recurrence. The radiation would be delivered in fractionation in high dose over 5 treatments (600Centigrade)

It takes about 1.5 weeks to plan, so Mark is in today to get mapped and fitted for the mask and start with preparations.

We are also working to  connect with Dr. Linda Liau for surgery consultation.  We are hoping to setup up a language eval, brain lab mri and functional mri so she can determine if surgery is a possibility.  We are still trying to schedule and hope these tests can be done soon so decisions can be made asap

more growth apparent

We went back for the first follow-up MRI after switching to the CCNU chemotherapy round. Unfortunately, the two hot spots got a little bit bigger, so it was determined that Mark's tumor does not respond to CCNU and a new plan of action needs to come in play.

From Dr. Cloughsey's perspective, he doesn't think surgery is an option because it looks like the tumor is in the motor and sensory areas and may cause problems with loss of function. He will be working with Dr. Linda Liau (neurosurgeon) for a final opinion on the feasibility of surgery.

Fortunately, the hot spot is in a pretty localized area and isn't lighting up in other parts of the brain. Because it is well localized, radiation (300 centigrade over 10 days) is an option paired with avastin (3omin intravenous every 2 weeks). This treatment combo has had good local control results and along with avastin's anti-tumor capabilities it also helps reduce swelling from radiation. Before we can do this, we'll need to set up a consultation with the radio-oncologist to see if he would be able to prepare the treatment based off the past 3 scans. I've already got all of the scans on a CD and have a call in to the radio-oncologist to set up an appointment.

Dr. C has already put in an order for the Avastin so we can get the ball rolling and make sure insurance issues are in order while we wait for word from both Dr. Liau and the radio-oncologist.

There is a phase 1 trial that Dr. C is also considering that involves delivering a certain virus to the tumor area through a biopsy. They have been getting good results, but the catch is that once the virus is inserted you have to watch it grow for 4 weeks while the virus gets activated to see if it is going to attack the tumor. At this point, Dr. C is favoring the radiation/avastin combination over Trials, since we can still do radiation while the tumor is still small.

So next step is we wait for Dr. Liau's recommendation and the radio-oncologist consultation