I didn’t sleep much last night. The last time I looked at the clock, the green digital numbers read 3:45 a.m. I was grinding on the realization that my 8:15 appointment (only 8-, then 7-, then 6-, then 4-and-change-hours away) would tell the story about whether or not the stereotactic radiosurgery had put a proper killing on the tumor in my spine. I thought I’d leave Dr. Pippas’ office this morning with that knowledge in hand.
I didn’t.
I did leave with a little bit of good news, though. The cancer doesn’t appear to be anywhere else in my body. It is localized to the place in my spine that has been biopsied twice (a week apart), operated on twice (eight weeks apart) and blasted with 32 grays of radiation (two treatments, nine months apart). My spine, though ravaged by surgery and radiation, is in a much better place than it was in just a few weeks ago when my spinal cord was being encroached upon by the tumor.
That is where the good news ends.
The tumor may not be dead. And, if it isn’t, Dr. Pippas thinks I may have reached the limit of how much treatment trauma (surgery and/or radiation) I can successfully stand in that spot. I haven’t had this conversation with my neurosurgeon or my radiation oncologist and I will do that. Before I address this any further, I’ll have those conversations. I’ll say at this point that my options appear to be narrowing. This tumor needs to go.
I need systemic therapy. The kind of therapy that courses through a body and kills cancer cells where they are — one by one, if that’s the way they come. I have sent the latest CT scan and yesterday’s MRIs of my lumbar spine and thoracic region to Dr. Janice Dutcher and Dr. Dan George for their review. We hope to be able to get a consultation with both of these fine physicians by the end of December and get scheduled for the HDIL-2 therapy as soon in January as possible.
HDIL-2 is the beast I’ve been reading about almost since the day of my diagnosis in May, 2009. I have read volumes about how the therapy is administered and hear dozens of first-person accounts of the actual treatment from members of the kidney cancer forum on acor.org. There is an 15% – 20% chance of a cure for people with clear cell kidney cancer. I want to be one of those people. I’m counting on being one of them.
Dr. Pippas, Jill and I talked this morning about the decisions we’ve made over the last two and a half years since I was diagnosed. I’m confident that we’ve made great choices. I’m at peace with all of the decisions we’ve made that, at the time, seemed like we were having to cut the baby in half. Right now, we’re standing at another crossroads. An important one.
Beginning with this next therapy, the price of poker is going up. Each one of the available therapies we try ticks off, one-by-one, the few available options we have to try. My hope is that I’ll only have to check off one of those boxes and it is the one that gives me a durable cure. Unfortunately, HDIL-2 is the only one that can do that. If it fails, then I’m on a train with no brakes going downhill with only pinestraw bales to stop me. Targeted therapies, tyrosine kinase inhibitors, vascular epithelial growth factor (VEGF) inhibitors are only band-aids that can’t cure me, but can lengthen my life until they stop working — and they will stop working.
So, this is why the HDIL-2 therapy is so important. It is the big arrow in my quiver and I’m ready to draw it back and let it fly.
I’ve done all I can do today. No sense in worrying about what I can’t control. Tonight, I hope I’ll sleep.