9 February 2009 - Results of 2nd MRI scan

Deb holding the new additions to our family - Flynn is on the left and Bertie on the right.

Today we went to the QE hospital and saw Dr Sanghera to discuss the results of Deb's second MRI scan since she had radiotherapy treatment. This second scan, taken on the 29 January, was compared to the baseline scan taken in November.

The results were not good. The latest scan showed that the active parts of the tumour had not responded to treatment and had significantly increased in size. This is real tumour growth and not pseudo-progression due to radiation effects.

We discussed various issues with Dr Sanghera:

1 Chemotherapy Deb's chemotherapy regime will change. Instead of a monthly cycle of 5 days chemo followed by 23 days off, she will now be given a lower dose of the chemotherapy drug (temozolomide) on a continuous basis. The new dose will be 100 mg per day (previous dose 380 mg per day during treatment).

2 Steroids As discussed in the blogpost on 12 January, following the last visit to the hospital Deb reduced her steroid dose to 1.0 mg per day. After a few days she found she started to have persistent headaches. After consulting the Macmillan nurse (Fred) it was agreed she should increase her dose to 3 mg per day. This increase did cure the headaches. Dr Sanghera thought the headaches may have been due to tumour growth and suggested Deb remain at a dose of 3 mg per day.

3 Blood tests Deb's blood test results today were good (WBC 12.5, RBC 4.2, Platelets 227). It was agreed that continuous chemotherapy would start today.

4 MRI Scan The next MRI scan is scheduled for 2 months time when the effect of the change in the chemotherapy regime will be assessed.

5 Surgery I asked again if surgery could be considered. Dr Sangera did not think that surgery would be a viable option but it would be discussed at the case conference meeting which will take place tomorrow.

6 Appointments Deb's next appointment at the hospital will be in 2 weeks time to have further tests to review the effect of the continuous chemotherapy on the blood.

I asked about Deb's prognosis given the scan results. Dr Sanghera did not know. He said we should concentrate on the positives ( doctors must be taught this phrase at med school. It was what the doctor said to me when I first went to the QE to talk about Deb's diagnosis and subsequently at every meeting when they have had to communicate bad news ). The positives are: 1) By scanning the change in the tumour has been caught early and the treatment can be adjusted 2) Some people have responded well to the continuous chemotherapy treatment and it may bring the tumour under control 3) If the continuous temozolomide treatment does not work there are other drugs that can be tried (this is most likely to be a combination of 3 drugs called PCV).

Can I ask family and friends not to call. Deb and I do not feel like talking about this right now. Deb will call you at some time over the next few days. Thanks.