I can't believe it's been an entire MONTH since I last updated! I suppose we were just basking in our delight at an MRI that proclaimed improvement. This morning we went to Salt Lake assuming the news would remain positive, or at least stable. What we weren't prepared for was this MRI report:
Examination: Brain MRI, without and with intravenous MRI contrast, 25 March 2008, 11:18 a.m.
Comparison: 25 January 2008
History: Primary malignant brain tumor, Pilomyxoid astrocytoma partially resected.
Findings: There has been interval enlargement of the heterogeneous mass that is centered in the suprasellar, anterior inferior interhemispheric, and septum pellucidum. The maximal craniocaudal dimension is 5.8 cm previously measuring 5.3 cm, width is 4.7 cm previously measuring 2.9 cm and AP dimension is 4.1 cm. previously measuring 2.9 cm. I see no evidence of remote CSF tumor spread.
In addition, there is progressive right more so than left lateral ventricular dilation. The third ventricle is unchanged.
Sooooo, in English, we learned that the tumor has grown. In two months it has grown half a cm front to back, and nearly half an inch both in width and top to bottom. The ventricles surrounding the tumor are also more dilated which indicates the spinal fluid might not be draining properly, which means a shunt might be in Matt's future. The good news is the part that says "no evidence of remote CSF tumor spread." Dr. Lemons talked to us about some options. We could begin radiation right away. I am nervous about this option because of the permanent damage that radiation will very likely cause to his endocrine system. The longer we can put it off, the better. I also like the idea of Matt finishing out the school year. Academically, I'm not worried about him, but springtime is the nicest part of the year! I want him to be able to enjoy these last weeks of school - because school defines who he is. Since radiation will be every day, he would not be able to attend school for the remainder of the year. The other option presented to us was a more aggressive chemotherapy regimen. The protocol is a six week cycle in which Matthew would take 3 different drugs. There are certain drugs taken each day for 4 weeks and then a 2 week break. We decided to try the chemotherapy for the hesitations about radiation that I already mentioned. Matthew will start tomorrow on Lomustine (also known as CCNU). We wait one week, and next Wednesday will go back to Primary's for an IV chemotherapy called Vincristine. That same day Matt begins Procarbazine, a pill that he takes at home everyday for 2 weeks. Eight days later there is another dose of Vincristine and then a two week break until the next cycle.
I am so anxious to see how he will handle this chemotherapy. With the previous two types, he has handled everything so well! The carboplatin made him sick, but I think we are much better equipped to deal with this possiblity this time. I have IV anti-nausea medications (3 different types!), as well as IV hydration that I can use if he can't keep food or liquids down. His blood counts have remained in the normal range for the past 8 months - with the exception of the first month, but I am beginning to suspect that was a fluke! Now we are beginning something new and that is always scary. Scarier than the side-effects, though, is the possibility that this chemotherapy will also fail..... I just want something to work so badly!