Update from George

We met with Dr. Myrna Rosenfeld who is the Division Chief of Neuro-Oncology a the University of Pennsylvania Hospital. The purpose of this visit was to get a second opinion on Donna's condition and treatment plan.

Dr Rosenfeld went through the various conditions and treatments plans that might be applicable depending on specific circumstances. The general result is that there is no additional or alternative treatment that Dr. Rosenfeld could recommend other than that which is currently being done by Dr Ostrovsky. The location and identification of a primary cancer is what needs to be further pursued. There is a lesion on one of her lungs, but its very small size and placement makes a definitive diagnosis difficult. Cancer of the bone or spine may also be a suspected primary cancer, however, there has been no indications of this and further scans, biopsies, and other tests will need to be done.

Additional Radiation Treatments: Dr Rosenfeld explained that it is not feasible to repeat radiation to the brain because of the damage that additional dose of
radiation would do. Radiation might be used for a very small and localized lesion and the beam would have to be very precisely placed.

Chemotherapy: is ineffective on brain lesions and can be administered only after identifying and locating the primary cancer.

Clinical Trials: There are no clinical trials underway that would be applicable to Donna's specific condition. Also, the lack of an identification of a primary cancer would preclude participation in clinical trial.

We also learned that the use of steroids in reducing the swelling in Donna's brain is a double-edged sword. Although the steroid Decadron is necessary to keep the intracranial swelling down, it also had the effect of reducing the function of major muscle groups which may be the cause of Donna's tiredness, loss of energy, and loss of mobility.It was suggested that a prolonged and very granular schedule for reducing steroid use be tried. We had tried this previously but perhaps the time was not long enough and the reduction was too much within a short time. We will discuss this with Dr. Ostrovsky during our next visit.

So the basic result is that we will continue with the current treatment and monitoring while continuing to identify the primary cause of the brain cancer.