Ox Fall Down

Tuesday afternoon/Delaney. Dianna walks over with me from Charles Street. Down we go into the basement of Mass General. Joking that you're in trouble when the machines they use on you are so heavy they have to rest underground. MGH is noisy. Very crowded. DFCI seems like a small town.

Delaney comes in and flips on the light board. The tumor looks larger and is now pressing against the stomach. This contact is problematic for standard radiation and also for proton beam radiation. (The difference between the therapies is in the length of dose. In the former the rays continue through the target area while in the latter the rays stop short at the far border of the target. Proton beam radiation delivers no exit dose. It spares a lot of healthy tissue behind the tumor. You just have to worry about the healthy tissue in front of the tumor.) Delaney still has three good portals. The only hitch now is the stomach involvement.

He suggests short term chemo to lift the tumor off of the stomach. Once the chemo has provided a margin he recommends commencing radiation. My concern is whether Demetri can guarantee shrinkage and, if so, will it peel off of the stomach? If he can't guarantee this wouldn't it be wiser to risk it immediately with the radiation? I'm worried that since the tumor is already growing the longer we wait the harder it becomes to apply any type of treatment.

Delaney understands this and actually agrees with the thought. He intends to speak with Demetri today.

Cycle structure:

Likely 7 weeks of treatment.
5 days a week.
Bank holidays off, otherwise, Monday through Friday.
Side effects include fatigue and nausea. I'll have to give up the job operating the back hoe.
More serious side effects could include stomach ulceration (with potential surgery). Delaney gives that a 1% or 2% chance. Also, there is a chance with any type of radiation that you could develop a late-symptom radiation induced tumor, unrelated to your original diagnosis. So, on top of liposarcoma you'd end up with another form of cancer, most likely some osteosarcoma. He puts those odds at 1 or 2 out of a thousand.

If you decide to roll the dice he thinks he has a good chance of knocking out this tumor. He's still treating an individual tumor rather than the cancer. The effect and not the cause. They call it disease management. You buy time. Sounds good to me.

He has me in line for a slot. Not sure when one would open up. It seems January at the latest.

That's all for now. I'll write again once I've heard from the doctors about their discussion.