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Dr. Rocklin Rocks

Tuesday, January 25, 2005 8:44 PM CST

Well, we finally talked to a doctor that had real information for us. We talked to Dr. Rockhill (Rocklin?) at the Gamma Knife Center at Harborview.

First: pathology report. Dave's tumor has not gotten more aggressive since last surgery. This is good news. It's still an Anaplastic Astrocytoma III. Tumors are graded from I-IV. I being a slower-growing, less infiltrating tumor and IV being the most aggressive and malignant. Dave's tumor was initially a grade II eight years ago. The tumors tend to become more aggressive over time. The best explanation of why is that during each treatment (radiation or chemo) you will kill off tumor cells. The cells that die first are the least aggressive, leaving the hardiest, most aggressive cells that multiply. Anyway, we were relieved that we are not dealing with a grade IV, more commonly known as GBM or glioblastoma multiforme.

Second: some of the tissue that was removed was necrosis. Necrosis is dead tissue from radiation. This can cause swelling and other problems. This is from his previous gamma knife treatment. It is difficult on an MRI to tell the difference between tumor growth and necrosis. Sometimes a PET scan can tell the difference, but not always. So it turns out that all the "growth" they saw on the scan was not live tissue. This is a good thing...it means the previous gamma knife did kill some tumor. The problem with radiation necrosis is that it can cause the same problems that the original tumor did. There is a pretty good explanation of all that at http://www.braintumorfoundation.org/tumors/gamma.htm

Third: some of the tissue they removed was LOWER grade. This is amazingly good news.

Fourth: the tumor board all agrees that the remainder of the tumor should be treated with gamma knife. The surgeon did not remove this last part because is is deep in the motor strip and he felt would certainly leave Dave with some left side paralysis. So they feel that treating it with gamma knife is the best way to go.

Fifth: the downside: Treating the residual tumor with gamma knife will almost certainly cause swelling in that area, which means that Dave will have some left-side motor problems. How much is not known. Initially, it will subside when treated with steroids and as time lets the swelling subside. The problem is that in 3-6 months when the cells of the tumor in that area begin to die off, we could face radiation necrosis again, which would cause left-side motor problems, which would likely be permanent and if the necrosis is bad enough, might require more surgery to remove it.

Our alternatives are to: 1) Do nothing and watch. This option is unacceptable. The tumor would grow and cause the same problems....and worse. or 2) Try another chemo to see if it would shrink the tumor. All the tumor board docs agree that since Dave is young and relatively deficit-free that the more aggressive approach is what we should do, even given the risks. They were not hopeful that the tumor would respond to any conventional chemotherapies, as it has already developed resistance to the best chemos available. After gamma knife, we will be adding a new chemo regimen, but it has a better chance to work in combination with the radiation.

So, we are scheduled for gamma knife on Thursday, February 3rd. We'll go to meet with both the gamma knife guy (Dr. Rock-n-Roll as Dave calls him) and the neuro-onc (Dr. Spence) on the Wednesday before. Dr. Rock also said that they would do an MRI and that there is the real possibility that the tumor will have grown enough in these two weeks since surgery to make it ineligible for gamma knife.

So that's the deal. Dave will get his staples out on Friday here in WW. HOORAY!

So prayer requests:

1. First, foremost, obviously and always: pray for complete and total eradication of every cancer cell from Dave's body.

2. Pray that the tumor will not grow so they can perform the gamma knife.

3. Pray the gamma knife will target the tumor, spare surrounding tissue and that Dave will experience minimal swelling and no problematic necrosis, so that he'll retain full use of his left side....he really wants to still be able to play his guitar!

4. Pray that the next chemo regimen will be the one that this tumor is sensitive to and that the chemo will kill any remaining cells and keep the tumor from growing.

I think that's it. If you've hung with me this far, thanks for reading, thanks for caring, thanks for praying. I hope I remembered everything.

Love you all, Shelley

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