I've been overwhelmed by procedures and pending decisions and information by a multiplicity of sources in the new(to me) and strange area of radiology for the past month. Comments from several of the docs involved are: "The stereotactic radiotherapy (Stereotactic Body Radiation Therapy--SBRT) for you has a very good chance of getting some result, is very unlikely to cure it, it may however more or less permanently control it." "I don't know if the damaged liver lobe will regrow after radiation as it would after surgery." "The main side effect of your SBRT is fatigue lasting from one week to one month." "You won't be considered for adjuvant follow-up chemotherapy for two months after the end of your stereotactic radiotherapy treatment." "After treatment, there is a 60-70% chance that the cholangio tumor will NOT grow back at the exact same spot." "The SBRT WILL likely stop all visible cancer in the tumor, which means that the tumor will likely stay where it is, but will NOT grow forward." "Although there is a 60-70% chance that the cholangio tumor will not grow back at the exact same spot, statistically there is also a 60-70% chance that metastases WILL grow elsewhere with ICC patients."
There's been a good bit of information to collect and digest. Next week, I see my chemo onc again and will inquire of his opinions about recommensing chemotherapy in place of radiation or following radiation. The radiology onc said there would be no adjuvant radiation to the exact same tumor location since I would be getting the highest allowable dose with the scheduled SBRT. Subsequent surgery is extremely unlikely due to marked scarring from radiation. Radioembolization with microspheres has been ruled out, as well. SO, my choices of traditional treatment are narrowing.
My choices of treatment are also narrowing by law, since I have now completed the transition from Blue Cross/ Blue Shield to Missouri Medicaid--which limits my choices to treatments and doctors to those practicing in the State of Missouri. (Ain't health care reform grand? But seriously folks.....).
The GOOD news for me is that CT scan results from 8/10/2010 indicate that the measure of my tumor reveals still-continuing shrinkage from 5.6 cm AP X 6.2 cm transverse on 6/17/2010 down to 5.4 cm AP X 5.0 cm transverse. It seems to be a little over half as big as it was when chemotherapy was started in early March this year. The other GOOD news is that the CT report said that there is still "NO CT evidence of metastatic disease.(!!!)" Thank God, nutritional supplementation, and chemotherapy!!
So, having passed through the CT scan hurdle, my old body appears to have qualified for the SBRT clinical trial. The radiation treatments, each lasting about an hour, are scheduled for the last week in August and the first week in September, and there are five of them.
The OTHER GOOD news for anyone qualified and interested is that my radiation oncologist at the Siteman Cancer Center/Washington University and Barnes/Jewish Hospital of St. Louis is seeking calls from those qualified and interested in participating in his SBRT clinical trials. I am emailing Marions with details, but he said he ONLY wants prescreened calls from those whose cancers have been determined to be non-resectable, preferably having been treated with the standard chemotherapy regiment for ICC or HCC, and with absolutely no metastases or lymph node involvement.