Downgraded

I've been downgraded (maybe)!

I don't know if you remember that Universitätsspital Zürich were going to do a second opinion of my tumour histology? Well they have, and they couldn't find any features of a grade IV tumour (GBM), so in their books I have a (anaplastic) astrocytoma grade III which is good news isn't it?

Well yes and no?

• It makes my mortality statistics slightly higher (but not by enough to think about)
• Both agree I have malignant tumours (thank goodness, I wouldn't have wanted all this nasty treatment otherwise)

BUT

• Some trails are now out of my reach because they favour GBM's (like the Tumour Treating Fields trial I kind of favoured)
• It introduces more uncertainty

Perhaps I'll feel better about this when I've got over the current Cold & Chemo bout.
Did I mention Carol & I should be off Thailand for a couple of weeks starting Sunday?

Tumour Treating Fields

Visit to Universitätsspital Zürich today to talk to a lady (Dr Magneto) about the Tumour Treating Fields (TTF) trial I mentioned back in November. I didn't learn too much more about the treatment except to find out that the "device" is more a rucksack than a handbag. The trial started in early 2006 and they have about half the participants they want so far, so there is a fair chance I will be in recurance before they finish!

An interesting little fact is that because the device is not a drug its not subject to the same complex regulations, so once the trial is finished (assuming statistically significant success) it will be available on the market almost immediately. Not that the my insurer will necessarily pay for it.

One interesting little point that Ms. Magneto mentioned in passing is that Universitätspital's current therapy for recurring GBM's is combined Avastin and CPT-11. This is a very interesting combination of an angiogenisis inhibitor (stops blood vessels from getting to the tumour) and a topoisomerase 1 inhibitor (normal tumour bashing chemotherapy). I need to read up on this a bit more.

Dr. Magneto had taken a look at the Histology from my Biopsy and she commented on the inconclusive results and offered me a second opinion from their labs. I, of course, took it.... more later.

Diagnosis & Treatment

Carol and I were a little suspicious when the Neurologist ask us to come into the hospital to get the diagnosis news rather than get it over the phone. So we quietly drove the 35km to the hospital to be told the bad news.

Essentially I have been diagnosed with the worst kind of Brain Tumor a Glioblastoma Multiforme with a survival rate of 25% at 2 years (with treatment). These tumours are incurable and the only hope is to slow down their growth with therapies such as Radiation and Chemo. It is most likely that this will kill me. That is quite a lot to take in.

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The rest of this posting is the technical details of the diagnosis:

Diagnosis: Glioblastoma Multiforme (malignant grade IV astrocytoma)

In order to get to this decision both cell pathology (histology) and tumour behaviour were taken into consideration

Pathology reported that all tumour cells were from brain material (primary tumour) and indicated a low grade astrocytoma with high grade areas found in one of the four samples taken during the biopsy. While Pre-surgery MRI's show that the tumour has pretty much DOUBLED in size in the 19 days between scans. This rate of growth is normally associated with high grade tumours.

Treatment:

Given the combined evidence of a Glioblastoma Multiforme , the tumour board decided to recommend standard treatment accordingly. This consists of 6 weeks of conformal 3D Radiation therapy to a total dosage of 60 Gray (maximum allowable dosage) concurrently with Temozolomid Chemo therapy followed by a further 6 cycles of Temozolomid (1 week in every 4) for the next six months.

Treatment cannot start until I have recovered from the Biopsy (basically until the scar has healed) because both Radiation and Chemo affect the healing process.