Did I mention that this process is a series of ups and downs, a winding road of highs and lows and of ever-changing emotions and ever-changing plans?
We have a new plan, a totally different plan, and Mark and I are very very pleased with it.
We are keeping the kidney, going to let it run its course, see just how much farther it can chug along. There are no guarantees with this little organ, it sure has been subjected to a lot and it has more to face, but the surgery was a success and we’ll leave it there and see what it can do.
We will proceed with radiation exactly as I described, starting this Monday and doing the first four days before taking Christmas and the weekend off.
And we will do chemotherapy. It is a high dose, much much worse than what we’ve been through before, but it only lasts seventeen weeks. There are a lot of details I will share tomorrow (or whenever I have a few moments) but here’s the thinking behind this shift.
This type of Wilms’, the kind he has now, has a higher propensity of metastasizing to the lungs or liver. This spreading is halted only by chemo. That’s the purpose of chemo: systemic control, hitting the whole body with a poison that can kill any hiding cancer cells. The purpose of radiation is local control: killing the cancer cells in the very spot they appeared.
We have removed the actual tumor (for the most part), so now we treat “locally” with radiation killing any cells that may have spilled in that location. And we treat “systemically” with chemo killing any cells lurking elsewhere. Doing both (and doing it much more quickly than my pie-in-the-sky plan to develop a specific drug-sensitivity profile –something that won’t be widely available for another ten years) gives us the best chance at long-term survival. Taking the kidney out may — or may not — up those chances slightly. It’s not clear, especially because it makes the “local control” issue somewhat redundant. We’d basically be hitting the local cells with a double whammy and doing nothing about the systemic cells.
Does this make sense? Well, I don’t really care if it does or not right now because we feel really really good. We plan to remove the dialysis catheter (yay!) and insert a Mediport (a much improved under-the-skin Broviac line) tomorrow and then go home. Yes, that’s right. Go home. Tomorrow.
This is not going to be easy. This chemo will be pretty brutal. But we did this past surgery for a reason. To see if we can save that kidney and still provide adequate treatment. We believe this will do that.
If someone had told us a week or a month ago that we’d be rejoicing the fact that our child was about to undergo twelve days of radiation and seventeen weeks of highly toxic chemo, we’d think they were crazy. But tonight, we are rejoicing.
This just might work.