Topic: Friend with hilar CC - starting chemotherapy - some concerns
I have posted earlier on these boards on behalf of a friend (58 years old) who found out in April 2012 he had a klatskin type 4 tumor, deemed unresectable because of portal vein involvement, and both sides of the liver impacted. He's had no treatment so far because of infections with the stents at first and then issues with his two external biliary drains. Finally now, his bilirubin count is down to 3.2, where he can start treatment.
Until yesterday, we were hopeful of a liver transplant (thank you so much to all the folks on this forum who replied and sent me the contacts), but on visiting Mayo Clinic in Jacksonville, we were told that he would not qualify for a LT anywhere because of the UNOS criteria of the tumor being <= 3cm and his tumor size is 4x5 cm. In any case, we have reached out and sent the reports to Dr Sonnenday at UM and Dr. Chapman at Barnes Jewish also to see what their take is on the possibility of LT, but it seems remote.
So, today, my friend is back at Moffitt Cancer Center in Tampa where they are starting him on systemic chemotherapy (no radiation yet). They are starting him off today with Gemzar only 600 mg/m2 once a week for 3 weeks, then nothing for 1 week, with no radiation treatment. The radiation oncologist wants to see how he responds.
They have ruled out Y-90 theraspheres because of the location and size of his tumor.
I'm a tad anxious about the mono drug chemo since it's already been three months with no treatment and would welcome any opinions and advice, and shared experiences, about the following:
1. Why are they not going with a combination of Gemzar with Cisplatin or some other combination?
2. Why are they not considering simultaneous radiation (either systemic EBRT, or localized brachytherapy)?
3. What about other options such as photo dynamic therapy (PDT) - Is this applicable only for extra hepatic CC?
I know these are questions for the doctors, but it's been hard to get a lot of information out of them sometimes.
Again, thank you so much for all the support and advice so far. It is definitely a comfort to be able to share and discuss these concerns.