7/21/02
Update
If my calculations are correct,
the lesions have grown between 11 and 16% since a month ago (colors match
pictures from 7/19/02 update):
A) Yellow ~ 12%
B1) Mint Green ~ 16%
B2) Bright Green ~ 15%
C) Pink ~ 11%
Conclusion: The main large lesions
are growing at a rate of about 10% per month.
The smaller lesions were
just barely visible on the last scans (in hindsight), so their percentage
growth is much greater and probably not accurate:
B3) Red ~ 345%
D) Orange ~ 205%
E) Blue ~ 29%
F) Purple ~ 64%
We are also concerned that there
could be yet another lesion in his occipital lobe just above the cerebellum.
I need to work to complete these calculations for the other four scans
as well, but it is very time consuming.
7/19/02
Update
The Scans - First Review:
We had Ben's sixth MR today.
We were disappointed with the results. We were hoping to see lesions
that were the same size, but instead they look slightly bigger. More
disturbing was the fact that there are three 'new' lesions. This
brings the total to eight visible lesions. I have artificially colored
the lesions for easy viewing and discussion.
One new lesion is at the
very top of his brain toward the front (see image
with orange highlight).
In hindsight, you can look back at his scans from last month and see the
same lesion, but it was very faint.
The other new lesion is at
the base of his brain in the cerebellum - he now has two in his cerebellum
(see image with blue and purple
highlight). In hindsight, you can look back at his scans from last
month and see the same lesions - but they were smaller and not as pronounced
- if you did not know they were there, you would not think they were lesions.
The third new lesion (red)
may be and extension of an existing lesion (highlighted in mint
green), but is in a new area of the brain (update on 7/24/02 - new
lesion, not an extension). You can also see the bright
green lesion. Note: We are concerned that Ben has another
lesion toward the bottom center of the left picture - the bright white
area (update on 7/24/02 - not a lesion).
Below are the big three lesions
we have been focusing on. I believe the light green and the dark
green lesions are actually separate lesions, contrary to what we though
in the past. The pink lesion is in his right temporal lobe.
The yellow lesion is the large one that could eventually cause hydrocephalus.
Ben also had a body CT.
We do not have those results yet.
The Decision:
On Monday, with the help
of Dr. Arceci (Johns Hopkins) and Dr. Etzl (PCH), we will be trying to
decide what to do next. We can stay on the same chemo, or move to
another chemo. Here are the options:
-
Stay on the same chemo - Prednisone,
Vinblastine & Methotrexate
-
Pro: More mild than the other
choices, less severe side effects. An acceptable path would be to
keep the lesions at bay for several years until they started to recess
on their own.
-
Con: May not be aggressive enough,
might not halt the growth of the lesions.
-
Con: Staying on chemo for the
long term may have some developmental impacts.
-
Etoposide (VP-16) plus Dexamethasone
(Decadron)
-
Pro: More aggressive chemo,
may stop growth, stop formation of new lesions or reduce size of lesions.
-
Con: Risk - Can lead to fatal
secondary leukemias.
-
2CdA
-
Pro: More aggressive chemo,
may stop growth, stop formation of new lesions or reduce size of lesions.
-
Con: Risk - Can knock out the
immune system quickly (hits the bone marrow), any infection can become
deadly.
-
Con: New chemo, no or little
experience administering it at PCH.
7/12/02
Update
