Treatment

We discussed our treatment options with our doctor - we could simply monitor the tumor with regular MRIs and hope that it is in fact a very slow growing cancer and discuss treatment when the tumor showed change.  It is a strange thought that I may have been carrying this cancer in my brain for a very long time without showing any ill effects.  We will never know this.  The doctor thought this wasn't the best option in our case and this made sense to us given that I had started to show some symptoms.

The second option would be treat with radiation therapy which is very effective at stopping cancer's growth and shrinking tumors and unfortunately, also very effective at killing healthy brain tissue.  Of course, doctors are getting better and better at delivering "safe" doses of radiation and targeting the radiation as much as possible.  However, because of the extent and diffuse nature of my cancer, I would have to get Whole Brain Radiation Therapy.  This type of therapy typically has acute, sub-acute, and long term side effects.  The acute and sub-acute aren't too pleasant but it is the not very well understood possibility of damage to cognitive function and early onset dementia 5, 10, 15 years down the road which is worrying to us.

The third option is to treat the cancer with chemotherapy.

Another unique aspect of brain cancer is the problem of finding a treatment to cross the blood-brain barrier which under normal circumstances, is a remarkable physiological adaptation which keeps anything unwanted and potentially dangerous from entering the brain.  Unfortunately, this also means that most chemotherapy medications are unable to cross the blood-brain barrier and attack cancer in the brain.

One of the the few chemotherapy drugs that can cross the barrier is temodar.  UCSF is running a phase II clinical study with temodar for patients with grade II cancer.  Temodar has been used effectively to treat patients with grade III and IV cancers so the trial is to find out if it can be used effectively on less aggressive cancer. We decided to participate in the trial and see if temodar alone can shrink, slow, or stop my cancer.

I have now finished three cycles of temodar and I seem to tolerate it fairly well.  I will get an MRI every two months to monitor any change in my tumor.  Since astrocytomas tend to be slower growing, they also tend to take more time to respond to treatment because of their slower rate of cell division.  So, even if the treatment is working, it could be six months or longer before we see  a change in the cancer that is perceptible from the scan.

I am generally feeling well (with a few exceptions that perhaps I'll go into later) and we are feeling optimistic about our treatment and the prospect of a good outcome.