Changes

Okay, so the game plan has changed a bit.  Went in early this morning to have blood work done in preparation for round #5 of chemotherapy tomorrow & before out appointment with Dr. Fanta this afternoon.  The blood work looked pretty good.  David's tumor marker has continued it's downward trend (on 8/6/13 it was 634, today it was 437).  His liver enzymes were markedly improved; the WBC count, RBC count, hemoglobin, and neutrophils were all at the bottom of the normal range; and the platelet count was once again low, but stabilizing a bit.  In other words, biochemically, his body has handled the toxic brew of Folfirinox quite well.  So, between Dr. Fanta (oncologist), Dr. Lowy (oncologic surgeon), & Dr. Murphy (radiation oncologist), they have concurred that the best plan of action at this point is to discontinue the chemotherapy and begin radiochemotherapy.  We have an appointment with the radiation oncologist tomorrow, but apparently the radiochemotherapy will involve localized external beam radiation therapy to the site of the pancreatic tumor along with an oral chemotherapeutic agent (Capecitabine) that not only makes the tumor more susceptible to the radiation, but also provides some systemic treatment to hopefully keep metastatic spread at bay.  Treatment is performed 5 days/week (Monday through Friday) for 5 to 6 weeks (a total of 28 treatments).  Not sure when treatment will begin, but it does take some time to get David's tumor mapped out for the computers on the linear accelerator to target the optimal area of treatment (probably 7 to 10 days).  After Dr. Fanta explained all of this to us, Dr. Lowy came in to meet with us as well & explained that David's tumor has responded biochemically to the chemotherapy without tumor growth or signs of metastasis on the recent CT study, now let's see if we can get some shrinkage and better tumor margination with chemoradiation, with the hope that David can have a good surgical outcome in the future.

I was incredibly encouraged by today's appointment.  I feel like we are two months ahead of schedule and still on the road to being a surgical candidate.  Psychologically David had geared himself up for four more rounds of chemotherapy and he was completely caught off guard by this new plan of action.  But, with a little more time to adjust to this new plan and get his head wrapped around a new weapon in this battle against pancreatic cancer, he will be up to optimal fighting mode and ready for action!

Here is my war cry .... fight the fight & be a survivor!!!!  Janet