Blogging in B Minor

I just read a story on MSNBC regarding the treatment plan for Senator Kennedy. It really just underscores the standard of care today with regard to malignant gliomas. As you know if you are a consistent reader, I have a grade 3 oligoastrocytoma. Although not publicly stated, most believe due to age and other statements that have been made that the Senator is dealing with a grade 4 glioma or a glioblastoma multiforme. Either way, the standard of care is mostly the same – surgery followed by concurrent radiation/chemo using Temodar followed by chemo (Temodar) and perhaps another chemotherapy drug such as Avastin. However, for grade 4 tumors, there are a lot of other options because of the sense of urgency.

Dr. Allan Friedman at Duke is performing the surgery and he is one of the imminent Neurosurgeons in the country if not the world and a giant in the world of research. I put up a post back in Janurary about a colleague of his, Dr. Henry Friedman (no relation) and a research slideset that he presented at the National Brain Tumor Fall Teleconference – Treatment Update for Brain Tumors. It’s highly technical in areas but it is worth going through. This slide set is also posted in my Resource Library along with many other resources that you might find valuable.  Dr. Allan Friedman heads up Neurosurgery at Duke while Dr. Henry Friedman is a Duke neuro-oncologist.

As of December, the Duke “Standard of Care” was described in this slide by Dr. Friedman – it includes a variety of options that you’ll find in the slideset including Gliadel wafers (embedded in a tumor cavity during surgery), the use of Avastin, Temodar, another chemo drug called Tarceva, CCNU and some clinical trials such as a vaccine they are working on:

I would recommend that you download the slides and go through them just to see what treatments are available and to see how deep these options can get. There is so much more to this than just going to your doctor and hearing a few things. I know many of you don’t do this so I am not inferring that – but I think we all need to be our own advocates and I would venture to guess that this material and the sheer volume of options can be intimidating to anyone – it is to me. Therefore, we need to keep going and stay on top of these options, even when we are well, just to know where the research is heading.

The take-away for me from today’s news? There is a standard of care and the absolute best that the world has to offer indicates that surgery followed by radiation (for me it was IMRT) and concurrent Temodar followed by 6 months to a year of Temodar (6 months is the general standard). Of course, this is different/tailored based on the case. As I stated, grade 4 tumors are an entirely different ball game because the survival rate is not very far out – so lots of options exist as shown above. But, the general decision tree and staples remain the same.

The bottom line is we are blessed to live in a world where so much exists to help us.

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