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