Treatment Information

31 January 2010
I called Dr. Akins office on Friday (29 Jan) to find out if my referral had been approved by Tricare and found out the original doctor that Dr. Akins wanted me to see wasn’t on the approved list, so I was being referred to someone else, and he is in the process of moving offices. I should find out something on Monday, 1 Feb.

I then talked to Dr. Akins and told him I wanted to go forward with the radiotherapy and to start the ball rolling. His office set me up with appointments on the following Thursday (4 Feb) for my mask fitting and the so-called tattoo markings on my neck for targeting. We also talked about treating my lymph glands in my neck and we agreed that radiotherapy was a better alternative to a radical neck dissection at this time. We also discussed using amifostine to mitigate the affects of radiation on my salivary glands. He didn’t recommend it, due to its side affects and lack of medical personnel to monitor me during its use. I wasn’t happy with that answer and fumed about it all the way home from work that afternoon. Dr. Akins said he would call Dr. Richards (hematology) and discuss chemo therapy alternatives. He is also contacting the dental clinic to have me evaluated to see if I need any dental work prior to the radiotherapy and to have them make me up some radiation splash guards for my teeth.

Once I arrived home I got a call from Dr. Richards, he asked if I could come in on Tuesday (2 Feb) to discuss chemo/anti-body treatment. He wanted to do this face-to-face rather than over the phone, but we still talked about the options. He said he had talked to Dr. Akins and that he had recommended using Erbitux (cetuximab) ((Cetuximab binds specifically to the EGFR on both normal and tumor cells, and competitively inhibits the binding of epidermal growth factor (EGF) and other ligands, such as transforming growth factor–alpha. Cetuximab can mediate antibody-dependent cellular cytotoxicity (ADCC) against certain human tumor types. Studies have shown that cetuximab inhibits the growth and survival of tumor cells that express the EGFR.)) I’m guessing all of that is good. Erbitux will have to be started a week prior to radiotherapy, so we need to make up our mind quick which drug we are going to use (erbitux or cisplatin). Erbitux has some pretty ugly side affects that pile on the radiation side affects so I’m not looking forward to its use.

We also discussed the use of Cisplatin, a platinum-based chemotherapy drug used to treat various types of cancers. It was the first member of a class of anti-cancer drugs. Platinum complexes react in vivo, binding to and causing crosslinking of DNA which ultimately triggers apoptosis (programmed cell death). Again, I guess this is good.
It also has ugly side affects.

Dr. Richards also suggested installing a central venous catheter ("central line", "CVC", "central venous line" or "central venous access catheter") is a catheter placed into a large vein in the chest (subclavian vein). It is used to administer medication or fluids, obtain blood tests. Certain medications are preferably given through a central line (i.e. cisplatin etc.) He also recommended installing a Percutaneous endoscopic gastrostomy (PEG). The purpose of a PEG is to feed patients who cannot swallow food and to provide fluids and nutrition directly into the stomach. A surgical opening into the stomach is made through the skin using a flexible lighted instrument (endoscope) passed orally into the stomach to assist with the placement of the tube and secure it in place.
Don’t these 2 procedures sound like fun? They’ve had trouble finding veins to take blood and for the biopsy procedure on the 8th, so the CVC is probably a great idea if I’m going to undergo chemo. The PEG on the other hand is a precaution to when or if I can’t eat due to the side affects of radiation/chemo. Two people I’ve talked to that have undergone the same treatment haven’t had a PEG installed. One didn’t need it, but the other probably did, he ended up in the hospital a couple of times due to dehydration.

So it looks I’m going to be having a great time over the next 2 weeks preparing for my treatments starting (hopefully) on 16 Feb.