Went to “planning session” at Dr.Amin’s office this morning – met and talked with Dr.Sinesi at length. The treatment plan has changed.
First of all, Dr. S. emphasized the importance of being able to keep up nutritionally during treatment, saying that the PEG gastric tube is best for this. Obviously nutrition by mouth is best and easiest, but as treatment progresses Dave will tend to develop mouth sores which can make eating difficult, and maintenance of proper nutrition is essential to his health.
Again the Dr. emphasized that radiation is for local treatment - tonsil and lymph nodes in the neck. Basically the radiation will treat an area (on both sides) from the top of the jawbone to the collarbone. Chemo is administered intravenously and the drugs flow throughout the body via the blood system. CAT scans can’t pick up tiny, microscopic cells that might be floating around, but chemo can attack those.
Chemo + radiation has a synergistic effect that enhances the effects of both – a 2+2=5 situation.
Dr.Atienza has been doing further research and both doctors agree that the cutting edge, “gold standard” of treatment would be to do two sessions of just chemo first, and then progress to the chemo + radiation 7-week program.
After the initial chemo treatments with Dr.Atienza, Dave will return to Dr.Sinesi and Dr.Amin for 2-3 days of planning – pictures, measurements, CAT scans, fitting of the mask – prior to beginning radiation treatment. It is probable that the “picture” at that point will be different from what it would be today – therefore it is prudent to wait till after chemo for this planning.
Dr.Sinesi told us to go directly to Dr.Atienza’s office to finalize discussions of the chemo plan, which we did.
After a long wait, Dr. Atienza came in to explain further all of the above, and to further explain the chemo treatment. Dave will undergo two sessions of chemo treatment over a three-week period. Raw data suggests that this plan is more effective and potentially easier for treating tonsil cancer. The “wrinkle” is that with the three drugs they will be using, there is some little risk.
Plan is now to start Chemotherapy on Monday 13 November. But first, I have an appointment for Friday the 10th to have the PICC installed.
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