Consult With Radiological Oncologist - January 04, 2010

First the biopsy results: Yes, the tumor in his brain has the same pathology (MFH sarcoma or Malignant Fibrous Histiocytoma) as the primary tumor removed from his arm 1 year ago and those found in his lungs in July. No surprise.

Dr. W-2 gave him 3 options: 1) no radiation, 2) stereotactic radiation, or 3) whole brain radiation. He explained each option. I’m going to try to describe what he told us to as accurately as I possibly can.

No radiation - The CT/MRI scans that were done immediately following the surgery showed the entire tumor had been removed. The problem here is that, just as the surgeon had explained immediately following the surgery, malignant cells can still remain but are too small to be detected by the scans. These cells can remain dormant and never change (unlikely), or they can take hold where they are, or migrate elsewhere, and establish another malignant mass (either or both of these are likely). He explained that the surgeon, having visually inspected the area, indicated recommendation to proceed to radiation therapy because he felt one of the “margins” was not sufficient to be confident that all cells were removed.

Sterotactic radiation – This is like GPS for radiation. The very concentrated beam is directed to the exact site of the tumor and radiates that area and a specified margin around the area, limiting the amount of radiation toxicity administered to a small area healthy tissue, a very good thing. He gave 2 choices for this treatment: standard or tomotherapy. Standard is administered over the course of a single day. It requires that the patient to be immobilized (essentially having your head in a brace with screws that go through the skin and contact the skull in about 4 strategic locations so it doesn’t move). It is uncomfortable, but it’s over in 1 long day. Tomotherapy uses a plastic mask that is molded to the patient’s head. It does not require clamps or screws so can be removed and replaced, assuring the patient’s head is in the same location as it was before. This way, they administer short doses of sterotactic radiation over the course of 5 days.

Whole brain – This is exactly what it sounds like. He explained that this therapy is recommended when there are multiple sites throughout the brain. The radiation is not as strong, and therefore may not be as effective, particularly with sarcoma which is fairly radiation resistant.

Pete opted for the Sterotactic Tomotherapy, so we moved to the next stage: preparation.


Thursday morning he has an appointment with the surgeon to remove the 24 staples that run up the back of his head. These have to be removed to allow for undistorted “stealth” MRI/CT images that will provide computerized, focused aim for the beam of radiation. These scans are scheduled for Thursday afternoon. I’ve changed the bandage several times and everything seems to be healing very nicely, but the surgeon will have the final word as to whether it has healed enough to begin.