Denault
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[edit] In Memory
[edit] Patient Information
Age: 33
Sex: Male
Diagnosed: 10/15/93
Location: Cranston, Rhode Island
Diagnosis: Stage IV DSRCT
Hospital Miriam Hospital Providence, RI
- Oncologist Dr. William Sikov
- Oncology Surgeon: Dr Paul Sugarbaker
- Consultant - Dr Brian Kushner
Passed Away: 09/98
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[edit] Treatment
Surgery
- First Debulking: Inoperable tumors. Found a tumor something between a golf ball and tennis ball in size extending from pancreas to stomach and appearing to infiltrate both organs (this assumption turned out to be incorrect). Found numerous metastases, small nodes seeding intestine, stomach, both omentums, diaphragm, aorta, and peritoneal wall. Disease was unresectable, took numerous biopsies, and closed up after four hours.
Chemotherapy
- CAP - Cytoxin-Adriamycin-Cisplatin
Surgery and Intraperitoneal Chemo
- Second Surgery - 9 1/2 hour surgery by Dr Paul Sugarbaker and Stevies. Large tumor was between pancreas and stomach, attached to the surface tissues of both organs, but invading neither. They were able to completely resect all the visible disease in abdomen. The resection required taking gall bladder, both omentums, and appendix. One tumor had completely penetrated diaphragm. Following this resection, heated (110 degrees Fahrenheit) cisplatin was introduced into abdomen and incision was closed. The surgeons had placed a catheter and four drains in abdomen, but had difficulty getting cisplatin to drain.
- After surgery, had adriamycin (body temp.) once a day for five days.
- Hospitalized for 22 days.
- Complications with cramping and diarrhea for about 20 months.
Chemotherapy
- ICE (Ifosmoside-Carboplatin-Etoposide)
Exploratory Surgery
- Dr. Sugarbaker found two small nodes of disease (an pencil eraser in diameter) on pancreas
Chemotherapy
- Taxol and Carboplatin, followed by Adriamycin - Four cycles
Surgery
- Third Surgery - Dr Sugarbaker finds a tumor wrapped around portal vein, extending to aorta. The tumor is essentially part of the vein and isn't resectable.
Chemotherapy
- Dr. Kushner recommends High dose cytoxan (5 grams/m2).
Stem Cell Rescue (bone marrow transplant)
- High dose thiotepa with stem cell rescue
- three cycles of thiotepa at roughly three week intervals
[edit] Time Line
| Date | Test | Treatment | Chemicals | Result |
|---|---|---|---|---|
| 9/93 | CT | 0 | 0 | Mass on pancreas |
| 10/15/93 | 0 | Surgery | 0 | Inoperable. Tumor size of golf ball extend from pancreas to stomach, also small nodes seeding intestine, stomach, both omentums, diaphragm, aorta, and peritoneal wall. |
| 11/93 | 0 | 0 | 0 | 0 |
| 12/93 | 0 | 0 | 0 | 0 |
| 1/94 | 0 | 0 | 0 | 0 |
| 2/22/94 | 0 | Surgery and Intraperitoneal Chemo | cisplatin | Able to resect all the visible disease in abdomen. Removed gall bladder, both omentums, and appendix. One tumor had completely penetrated diaphragm. |
| 2/24/94 | 0 | Chemotherapy - through cathetar into abdomen | Adriamycin - once a day for five days | 0 |
| 3/94 | 0 | Chemotherapy | ICE (Ifosmoside-Carboplatin-Etoposide) | 0 |
| 4/94 | 0 | Chemotherapy | ICE (Ifosmoside-Carboplatin-Etoposide) | 0 |
| 5/94 | 0 | Chemotherapy | ICE (Ifosmoside-Carboplatin-Etoposide) | 0 |
| 6/94 | 0 | Chemotherapy | ICE (Ifosmoside-Carboplatin-Etoposide) | 0 |
| 7/94 | 0 | Chemotherapy | ICE (Ifosmoside-Carboplatin-Etoposide) | 0 |
| 8/94 | 0 | Chemotherapy | ICE (Ifosmoside-Carboplatin-Etoposide) | 0 |
| 9/94 | 0 | 0 | 0 | 0 |
| 10/94 | 0 | 0 | 0 | 0 |
| 11/94 | 0 | 0 | 0 | 0 |
| 12/94 | 0 | 0 | 0 | 0 |
| 1/95 | 0 | 0 | 0 | 0 |
| 2/95 | 0 | 0 | 0 | 0 |
| 3/95 | 0 | Exploratory surgery - Dr Sugarbaker | 0 | Found two small nodes of disease (an pencil eraser in diameter) on pancreas |
| 4/95 | 0 | Chemotherapy | Taxol and Carboplatin | 0 |
| 5/95 | 0 | Chemotherapy | Taxol and Carboplatin | 0 |
| 6/95 | 0 | Chemotherapy | Taxol and Carboplatin | 0 |
| 7/95 | 0 | Chemotherapy | Taxol and Carboplatin | 0 |
| 8/95 | 0 | Chemotherapy | Adriamycin | 0 |
| 9/95 | 0 | Chemotherapy | Adriamycin | 0 |
| 10/95 | 0 | 0 | 0 | 0 |
| 11/95 | 0 | 0 | 0 | 0 |
| 12/95 | 0 | 0 | 0 | 0 |
| 1/96 | CT | 0 | 0 | Indicates something may be going around liver. |
| 2/96 | MRI | 0 | 0 | Also, indicates something may be going around liver. |
| 3/13/96 | 0 | Surgery - Dr Sugarbaker | 0 | Found tumor wrapped around portal vein, extending to aorta. The tumor part of the vein and isn't resectable. |
| 4/96 | 0 | Chemotherapy | High dose cytoxin | 0 |
| 5/96 | CT | Chemotherapy | High dose cytoxin - discontinued | No change in tumor |
| 6/96 | 0 | 0 | 0 | 0 |
| 7/96 | 0 | 0 | 0 | 0 |
| 8/96 | 0 | Stem Cell Rescue | 0 | 0 |
| 9/96 | 0 | Stem Cell Rescue | 0 | 0 |
| 10/96 | 0 | Stem Cell Rescue | Thiotepa | 0 |
| 11/96 | 0 | Stem Cell Rescue | Thiotepa | 0 |
| 12/96 | 0 | Stem Cell Rescue | Thiotepa | 0 |
| 1/97 | 0 | 0 | 0 | 0 |
| 2/97 | 0 | 0 | 0 | 0 |
| 3/97 | 0 | 0 | 0 | 0 |
| 4/97 | 0 | 0 | 0 | 0 |
| 5/97 | 0 | 0 | 0 | 0 |
| 6/97 | 0 | 0 | 0 | 0 |
| 7/97 | 0 | 0 | 0 | 0 |
| 8/97 | 0 | 0 | 0 | 0 |
| 9/97 | 0 | 0 | 0 | 0 |
| 10/97 | CT | 0 | 0 | No tumors seen, but having problems with common bile duct. Tumor suspected to be compressing. |
| 11/97 | 0 | 0 | 0 | Discussed surgery |
| 12/10/97 | 0 | 0 | 0 | Doctors no longer recommend surgery |
| 1/98 | 0 | 0 | 0 | 0 |
| 2/98 | 0 | 0 | 0 | 0 |
| 3/98 | 0 | 0 | 0 | 0 |
| 4/98 | 0 | 0 | 0 | 0 |
| 5/98 | 0 | 0 | 0 | 0 |
| 6/98 | 0 | 0 | 0 | 0 |
| 7/98 | 0 | 0 | 0 | 0 |
| 8/98 | 0 | 0 | 0 | 0 |
| 9/98 | 0 | 0 | 0 | Passed Away |
6y
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