A new plan

My wife Teresa and I went to see our oncologist Friday, April 27. Based on that meeting, it looks like we have a plan for what to do about my three (or conceivably four) rogue tumors, and it’s a straightforward one: Sloan Kettering will probably treat them with radioactive pellets of a substance called Yttrium.

            This is good on a bunch of counts. First, it means we don’t need to start traveling somewhere for a clinical trial. Instead, I can continue to be treated by Sloan Kettering, which knows my case and which is also easily available if something goes wrong. The clinical trials we were beginning to think about were in Boston, Bethesda (near Washington, D.C.) and Houston – not so convenient!

            Second, it means we’re not moving into the world of clinical trials of experimental treatments. Those treatments are interesting and may be promising, but they are all more or less unknown quantities. Using Yttrium pellets is considerably more familiar territory.

            Third, our oncologist believes this treatment will make a real difference. We were concerned that there might be no point in attacking these rogue tumors by themselves, and that instead we might need to completely switch my treatment plan. We were worried that even if a selective attack on just these tumors destroyed them, more would spring up as soon as these were dealt with. But the oncologist said that she doesn’t treat things just because they’re there; she wants the treatment to make long-term sense. Why does going after these tumors make sense? The very encouraging answer is that she thinks the biology of my particular cancer is in my favor; my cancer – with the exception of the tumors we’re going to attack -- seems slow-moving and uninterested in leaving my liver. She feels that I’m an outlier among cholangiocarcinoma patients – in a good way. (Of course I say all this with fingers crossed!)

            This won’t be a done deal until we go see the “interventional radiologist” who would actually do the Yttrium treatment, who not incidentally already works closely with our oncologist. Conceivably he could recommend some other way to proceed, but that doesn’t seem likely. Assuming we go ahead with this approach, there’d be a session with the interventional radiologist for him to map the targets in my liver, and then another session for the actual procedure. Chemotherapy may also get added to the mix.

The procedure itself, as I understand it, is called “selective internal radiation therapy” (SIRT), and, aside from the fact that I hope it works, it’s really pretty amazing to learn about. In this treatment, they run a catheter from my groin via the femoral artery up to the liver, and then they send tiny glass beads infused with Yttrium-90 – millions of them! -- through this catheter. The beads embed themselves in the tumors’ blood vessels (this is clever of them – it’s a result of there being more blood flow in the tumors than in the healthy liver around them). Then they emit radiation, almost all of it within about 11 days and traveling only a quite short distance, so the rest of me shouldn’t be much affected. Meanwhile I go home, I believe the same day as the procedure. Side effects are likely to be mild. Direct effects on the tumors, I hope, will not be mild but intense.

And that’s the plan!