From Scratchpad

Contents 1 In Memory 2 Patient Information 3 Treatment 4 Time Line

[edit] In Memory

Nathan

[edit] Patient Information

Age: 17

Sex: Male

Diagnosed: 3/3/05

Location: Maine

Diagnosis: Hypothroidism and Stage IV Desmoplastic small round blue cell tumor

Hospital Barbara Bush Children's Hospital

First Pediatric Oncologist - Virginia Hamilton, M.D.

Second Pediatric Oncologist - Eric Larsen, M.D.

Pediatric Oncology Surgeon - Baird Mallory, M.D.

Other members of the MCC Pediatric Oncology Team

Pediatric Oncologist Ashley Speckhart, MD

Pediatric Oncologist Anne R. Rossi, MD

Pediatric Pain and Palliative Care SpecialistCraig A. Hurwitz, MD

Hospital University of Pittsburgh Medical Center Shadyside

Adult Oncology Surgeon - David L. Bartlett, M.D.

Clinic

Maine Children's Cancer Program

Dana Farber Cancer Institute/Jimmy Fund Clinic

Karen Albritton, MD

Stem Cell Transplant Program

Jennifer Clark, MD

Leslie Lehmen, MD

No evidence of disease: 1/17/06

Relapse 9/25/06 - New spots found sandwiched between dome of liver and right diaphragm

4/17/07 - 4cm tumor located behind the prostate identified.

2/11/08 - Passed away

Caringbridge Journal

Back

[edit] Treatment

• First Line High Dose Chemotherapy:

HD-VAC = Adriamycin (Doxorubicin);Cytoxan (Cyclophosphamide); Vincristine

Mesna

Ifosfamide, Etoposide

• Second Line Chemotherapy

Irinotecan, Temozolomide (Temodar)

• Third Line Chemotherapy

Cytoxan (Cyclophosphamide) ; Topetecan

• Clinical Trial

OSI-930

• Off Trial Chemotherapy - First

Sunitinib (Sutent)

• Off Trial Chemotherapy - Second

Sorafenib (Nexavar)

• Surgery

Biopsy lympth nodes/bone marrow

Central line (3)

Bi-lateral bone marrow biopsy

Surgical Debulking - 75% tumors removed

Cytoreduction Surgery - all visible tumors removed

Intraperitoneal Hyperthermic Chemoperfusion

Mytomycin C

Surgery to remove twenty 2cm lesions on dome of liver. Removed 90% of right diaphragm, replaced with synthetic

• Autologous Stem Cell Rescue

Stem cells apheresised (harvested)

No radiation as of August 2006

• Complication

1st blood clot in lungs 2005 orginate from hepatic artery 2nd Partial hepatic blood clot in liver in 2007

Medication

Levothyroxine Daily - 88ml for Hypothyroidism

Sarcoma and Thyroid Disorders

[edit] Time Line

Date	Test	Treatment	Chemicals	Result
3/05	Baseline CT , Chest Xray	Surgery, Biopsy, Cathetar	0	Central line placed, bone marrow and lympth nodes clear
3/9/05	0	Chemotherapy Cycle 1 -HD-VAC Diuretic for ascitis	Doxorubicin, Cytoxan, Vincristine + Mesna	Diuretic works
3/13/05	CT	Blood thinner	Heparin	ICU 3 Embolisms in lungs. Clots origniated in hepatic artery
3/30/05	0	Chemotherapy Cycle 2	Ifosfamide, Etoposide	0
4/21/05	CT	0	0	20% decrease in tumor size
4/22/05	0	Chemotherapy Cycle 3 HD-VAC	Doxorubicin, Cytoxan, Vincristine Mesna	0
5/12/05	0	Chemotherapy Cycle 4	Ifosfamide, Etoposide	0
5/18/05	0	Central Line Infection	Antibiotics	Klebsiella, bacterial infection
6/2/06	CT	0	0	Significant tumor shrinkage, primary tumor 50%
6/8/05	0	Chemotherapy Cycle 5 HD-VAC	Doxorubicin, Cytoxan, Vincristine + Mesna	0
6/29/05	0	Chemotherapy Cycle 6	Ifosfamide, Etoposide	0
7/19/05	CT	0	0	More shrinkage, disappearance of number tumors
7/27/05	0	Debulking Surgery	0	75% of tumors removed, unable to remove hundreds of tumors on diaphram, one near large bowel, or spleen
8/9/05	CT	0	0	Possible new spots in lung and liver
8/9/05	0	Chemotherapy Cycle 7 HD-VAC	Doxorubicin, Cytoxan, Vincristine + Mesna	0
8/9/05	CT	0	0	Oddity about appendix
8/9/05	Biopsy	0	0	Cancer cells still alive
8/31/05	0	Chemotherapy Cycle 8	Ifosfamide, Etoposide	0
9/20/05	0	Chemotherapy Cycle 9	Doxorubicin, Cytoxan, Vincristine + Mesna	0
10/21/05	Baseline CT	Surgery-Intraabdominal Hyerthermic chemoperfusion	Mitomycin C	Removed all visible tumor and spleen
11/05/05	0	Central Line Infection	Antibiotics	Low grade
11/10/05	CT	0	0	Spots on lung
11/14/05	0	Removed Central line	0	0
11/16/05	0	New Central line put in	0	0
11/17/05	0	Chemotherapy 1	Temodar and Irinotecan	0
12/13/05	0	Chemo 2	Temodar and Irinotecan	0
1/6/06	Blood test - elevated eosinophile	0	0	Unusually high eosinophile levels
1/17/06	CT	0	0	No evidence of disease
1/17/06	0	Chemo 3	Temodar and Irinotecan	0
2/14/06	0	Chemo 4	Temodar and Irinotecan	0
3/31/06	0	Chemo 5	Temodar and Irinotecan	0
4/11/06	CT - Chest/pelvis/abdomen	0	0	No evidence of disease
4/24/06	0	Chemo 6	Temodar and Irinotecan	0
5/22/06	0	Chemo 7	Temodar and Irinotecan	0
6/06	0	0	0	0
7/12/06	CT	0	0	no evidence of disease
7/14/06	PET	0	0	No evidence of disease
7/31/06	0	0	0	0
8/2/06	0	Day Surgery	0	Remove cental line
9/25/06	CT	0	0	Relapse. 2 spots of concern found on the right between top of liver and diaphragm.
10/24/06	CT	0	0	Full body scan. Two spots about 1 cm can now be clearly seen
10/27/06	0	0	0	Consultation at Dana Farber Jimmy Fund Clinic. More chemo, possible stem cell and/or radiation.
11/6/06	Ultrasound	0	0	0
11/8/06	0	Surgery	0	Central line
11/9/06	PET scan	0	0	2-3 spots about 1cm each lit up. No other cancer seen.
11/13/06	0	Chemo 1	Cytoxan and Topetecan	0
12/04/06	0	Chemo 2	Cytoxan and Topetecan	0
12/18/06	0	0	Bi-lateral bone marrow biopsy	Bone marrow clear of disease.
12/21/06	CT to check response of 2 rounds of chemo	0	0	Nodules between liver and diaphragm unchanged. No new growth.
1/4/07	0	0	0	Consultation at Dana Farber about Stem Cell Rescue
1/15/07	0	Chemotherapy - Cycle 1	Ifosfamide, Etoposide	0
1/30/07	0	Stem Cell Harvest at Boston Childrens Hospital	0	Got enough in 2 days
2/5/07	PET	0	0	Cancer unchanged, no new spots
2/6/07	0	Chemotherapy - Cycle 2	Ifosfamide, Etoposide	0
2/11/07	0	Low blood count	0	Blood transfusion (2 units)
2/26/07	0	Chemotherapy	Temodar and Irinotecan	0
3/5/07	CT	0	0	Cancer unchanged, suspicious spot on lower lobe of liver
3/6/07	MRI	0	0	Found partial hepatic blood clot. Spot is benign, fluid filled cyst.
3/22/07	Chest x-ray	0	0	Baseline for surgery
3/28/07	0	Surgery to remove cancer on dome of liver	0	Removed all visible signs of tumor. About 20 quarter sized tumors on right diaphragm. Removed 90% of right diaphragm and for margins a slice of the liver. The tumors had been pressing down on the dome of liver and had not penetrated the liver membrane.
4/12/07	0	Chemotherapy	Cytoxan and Topetecan	0
4/27/07	CT	0	0	Area of concern in pelvic area. Diaphragm clear.
4/30/07	Ultrasound	0	0	Liver looks clear.
5/4/07	MRI	0	0	Confirm mass in pelvis, unclear what it is
5/7/07	PET	0	0	Lighting up in pelvic area, confirmed disease
5/17/07	Endoscopic Ultrasound	0	0	Confirmed 4cm mass behind prostate
6/07	0	Chemotherapy	Irinotecan, Temodar	Small spot of disease between liver and diaphragm. Decided to not do surgery.
7/07	0	Chemotherapy	Irinotecan, Temodar	0
8/20/07	0	Clinical Trial	0SI-930	0
9/07	PET	Clinical Trial	0SI-930	Scans of tumors not as bright as one taken in August
10/31/07	CT	Clinical Trial	0SI-930	Stopped clinical trial. New growth along right pleural lining of lung.
11/07	0	Chemotherapy - Sutent	0	0
12/22/07	CT	0	Stopped sutent as he was having intestinal spasms	CT showed little change from last one. Hospitalized for four days.
12/07	0	Chemotherapy changed from Sutent to Sorafibnib	0	0
1/8/08	0	0	0	Hospitalized with fluid in lung, breathlessness, and lower back pain on right side
1/24/08	CT			Disease has grown and spred rapidly since last scan, now covering right lung, diaphragm, chest wall, liver . . like frosting.
1/25/08	0	0	0	Home on hospice
2/11/08	0	0	0	Passed away

Contact: dsrct.wiki@gmail.com

BACK

User:Kalimac