I lit out from Reno, I was trailed by twenty hounds

Just an update from my excursion to Sunnybrook Hospital in Toronto last week.  I went to see Dr Patrick Cheung, a radiation oncologist, about using targeted radiation on the stubborn metastases in my lungs.   Dr Cheung explained to me that generally this is used on mets where either:  a) a person has had only a few mets from the beginning, as a way of potentially ‘curing’ or getting them to ‘no evidence of disease’; or b) where a person has a number of mets, mostly stable, but one or two growing, which need to be caught and stabilized, as a way to extend survival.

My situation is a bit more complicated because while I have only a couple of stubborn mets, they are not growing; but neither have there only been a couple since the start (there were at least 16 tumours, 8 per side, last May when things were least under control).

Notwithstanding this, Dr Cheung said he was willing to do the therapy, with a goal of stopping/stabilizing the stubborn mets, to provide a treatment ‘holiday’.  This would be beneficial both to determine whether the other 14 were actually eliminated by Sutent (not just made too small to see), but also to give a break to my heart, thyroid, liver, and remaining kidney, all of which have a hard time on Sutent, and a break to me from the feet/mouth/stomach side effects.

I made a chart at the end of my visit that looked like this:

Pros:                                                                                       Cons:

1.  at least a brief (3 month) Sutent holiday guaranteed              1.    likely short term fatigue, dry cough, and LT small scarring to lung.

2.  possibility of a longer treatment holiday if former spots           2.   possibility of radiation-induced pneumonia, treated w steroid – 5%

     do not regrow (months or years) – possible

3.   potential to inhibit future mets (potential – not proven)           3.  unknown – probability that regrowth is Sutent-resistant.

When I asked Dr Cheung about the ‘unknown’ – possibility of Sutent-resistant regrowth – he said ‘no, that isn’t an issue’.  I thanked him, and said I wanted to follow up with my oncologist about this, but that I’d probably want to proceed with radiation.

I was very excited in discussing this with my friends and family late in the day after this appointment.  (Had been up since 3 a.m. but stayed up fairly late due to travel back and excitement).  On the plane on the way home, I’d even had a small cry only because I was acknowledging the possible upside — a long period of time off treatment, feeling well, being back to myself – and hadn’t allowed myself to feel this kind of hopeful in so very long.

Unfortunately, on Wednesday I heard from my oncologist.  Although most people do not end up with Sutent-resistant RCC following a treatment break, a significant minority (25%) do.  Prior to hearing from her, I’d thought to myself that I’d be able to live with a 5-10% risk, but anything higher (20%+) would be too much, given that Sutent was essentially keeping things stable at the moment.

So that’s where things are at.  I guess if my tumours begin to grow, I might reconsider; but for now, the devil I know seems more acceptable than the devil I don’t.  Image

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