My ex-husband, Joe, is a long-term survivor of primary central nervous system
lymphoma. This is a deadly brain tumor with only a 2-3% five year survival after standard
treatment. It has been over 22 years since his diagnosis and Joe has been off all treatment
for nearly 20 years now. He is also well and fully functional. Joe is a cpa-lawyer who
specializes in the valuation of pensions and businesses for divorce proceedings. He
spends much of his time being grilled as an expert witness in court proceedings and was
recently listed in the '100 Best Lawyers in America' book. Except for some mild
forgetfulness, his intellectual abilities appear to be unscathed. Joe is also physically
active, and most importantly, still here to be with our family which now includes our beautiful 3 year old granddaughter.
But, it was a long journey from the diagnosis to his current condition.
In September of 1984, a CAT scan revealed a 3cm mass in Joe's third
ventricle. The neurosurgeons at our local community hospital informed us
that this was an inoperable location and that, at the age of 37, Joe should
get his affairs in order. After a night of hysteria, I pulled myself
together and decided to become Joe's advocate. No one was making any attempt
to refer us and I realized I would have to do it myself. If the worst did
happen, I wanted to be able to look our two young sons in the eye and tell
them that I had done everything I could to save their father. My efforts
would lead to two new treatments that were unavailable in our home state of
Michigan.
I sent out a call for help to everyone we knew and, fortunately, two
of our friends were related to an orthopedic surgeon at the Mayo Clinic.
This surgeon checked with the neurosurgery department and found out that a
neurosurgeon new to Mayo, Dr. Patrick Kelly, specialized in deep brain
tumors. Dr. Kelly was awaiting my call. Over the phone, he described his
technique, called computer-assisted sterotactic laser surgery, and I was
blown away. Dr. Kelly's technique uses a computer-guided laser beam to
vaporize deep tumors layer by layer. It was more precise and caused less
damage(and swelling) to surrounding normal brain tissue than standard
surgery. Four hours later Joe and I were on a plane to Minnesota.
The long surgery was highly successful- over 99% of the tumor was
gone- with no brain damage. Even Dr. Kelly called it a miracle. But, the
biopsy was unable to establish a diagnosis. Even after sending the slides to
the best neuropathologists around the country, there was no consensus. We
decided to abide by the majority opinion, which was that of a low-grade
astrocytoma. After much agonizing and research in the medical library, we
decided that Joe should have 5000 rads of radiation to the tumor and the
immediate surrounding area. This was done at a major medical center close to
home.
One month after the radiation was finished, Joe again began to have
headaches. A CAT scan revealed a second tumor in a completely different area
of the brain. We knew it had to be highly malignant to recur so quickly.
Back at Mayo, Dr. Kelly did a stereotactic biopsy which confirmed his
suspicions. We finally had a diagnosis- Joe had a primary central nervous
system lymphoma. These tumors, unlike gliomas, tend to occur in multiple
sites throughout the central nervous system.
The neurooncologists at Mayo had little to offer. Radiation did not
produce a durable remission and the tumor was so rare that they had never
given chemotherapy for it before. This, along with the fact that I no longer
trusted anyone, spurred me to return to the medical library. After many
hours of searching the Index Medicus and references at the back of
articles(no Internet back then!), I found an article written by Dr. Edward
Neuwelt of Oregon Health Sciences University in Portland. He was a pioneer
in a chemotherapy treatment called blood-brain barrier disruption(BBBD)
which temporarily breaks down the brain's guard allowing high concentrations
of chemotherapy to reach the tumor. It was especially effective in treating
CNS lymphoma. The only other treatment I could find was a less aggressive
one offered by a physician at Dana Farber in Boston. As we struggled to
decide, I asked both physicians the 24K question: how many patients have you
treated and how are they doing? The physician at Dana Farber was evasive and
never answered the question(I would later learn there were NO survivors). On
the other hand, Dr. Neuwelt was very open and told us that he had treated
nine people with one alive three years and another for two. It wasn't much
to go on, but this was much better than 2-3%. At that time, BBBD was a phase
II clinical trial available no where else in the country (it is now a
multicenter phase III trial). So, now it was off to Portland.
BBBD is a rigorous treatment, done in the hospital and requiring
intubation and an overnight stay in intensive care. But, it was well worth
it- after only one treatment 90% of the tumor was gone and after a second
round of BBBD we never saw it again.
Thus, by overcoming my own despair and becoming my sick husband's
advocate, I had been able to find two very new and little-known treatments.
Joe was one of the first 70 people in the United States to have
computer-assisted stereotactic laser surgery and the tenth person to receive
BBBD.
There were other factors in Joe's recovery as well. I pumped him full of high
doses of anti-oxidants (Vitamins C, E, beta-carotene, and selenium) which may have
cancer-fighting properties. However, as anti-oxidants can also potentially interfere with
treatment, especially radiation, please check with your physician before using these. Joe
also practiced guided imagery where he imagined his white blood cells destroying the
tumor. This, and his strong religious beliefs, were very helpful emotionally.
So, my overall message to you is don't give up. Use all the resources available,
which are far better than when I was helping Joe. I If your physician is not aware of a treatment, show him/her a medical journal article or its listing in PDQ, ClinicalTrials.gov, or Virtual Trials.
And if he/she is still leary, check it our yourself. Investigators of clinical trials WILL talk
to patients. And, my experience has been that the best ones are also the nicest. For more information about the BBBD treatment Joe received go to www.ohsu.edu/bbb. For
general information about clinical trials, I recommend the paperback book 'Cancer
Clinical Trials' by Robert Finn which is available through Amazon.com. In the intervening years since I originally wrote this story, I have completed a master's degree and am a practicing physician assistant in Internal Medicine in addition to keeping up on brain tumor treatment and continuing my volunteer work as a cancer patient advocate.
Please feel free to send me a message below if you have any further questions. The best
of luck to you!!
Lydia Cunningham Rising
