Tumor Board

Tuesday, August 17, 2004 1:13 PM CDT

We met with doctors at Harborview yesterday. Dave has a new growth in his right frontal lobe. This new growth is very small, but it was not evident at his MRI in May, and shows on the MRI in July. It's quite scary that it has grown so quickly, and is in a new place. It's also scary that it grew while Dave was on temodar (chemo).

The doctors from the tumor board are recommending gamma knife. Gamma knife is high intensity radiation that is very accurate and focused on the tumor growth. There are 201 beams aimed at the tumor. (See the main page for a link to information about gamma knife, you have to scroll to the bottom.)

On Thursday, August 19, 2004, Dave will undergo gamma knife at Harborview in Seattle. We are hoping that this will halt the growth of the tumor.

He will go into the hospital at 7:00 am and they will place a halo or frame around his head, by screwing it into his skull (ouch! They will give him some IV pain meds). They took x-rays yesterday to determine the exact placement, because they want to avoid the area of his past surgeries, because this area is vulnerable to fracture.

Then they will do an MRI to determine the exact area of the tumor. Then they meet to plan the radiation exactly. Then Dave will be placed into the gamma knife machine. Depending on the shape and size and complexity of the growth, he will receive 1-4 "shots" of radiation, each consisting of 201 beams. They say this takes 1-3 hours.

The first MRI after radiation typically looks worse than before because of the swelling. The radiation will ruin the DNA of the tumor cells so it cannot multiply. So we won't know for 3-6 months how well this worked.

Most people tolerate the procedure pretty well, with minimal headaches and nausea. It can induce seizures, however, so they want him to stay in Seattle on Friday. Long term, there are two scary things. One: Dave has a large blind spot in his left eye, a result of the last surgery in June 2003. This gamma knife procedure could possibly damage the vision in his right eye. If that happens, he won't be able to drive. As you can imagine, he's not too keen on that happening.

Another danger is that since Dave has had radiation previously, he has about a 15 percent chance of developing radiation necrosis, which is proliferation of dead cells. This can cause the same problems the tumor does and would have to be removed via another surgery.

We will also have to meet with the neuro-oncologist in Seattle, because the temodar is obviously not working, and we need to decide what route to take.

So, please, please, pray for Dave on Thursday, pray for the doctors, too. Pray for God to heal him of this new tumor completely.