Abi’s Options

In February 2012, we went to see Abi’s Oncologist, where I learnt that the medical team there wanted her to go on a chemotherapy regimen of carboplatin and vincristine. What came as a shock was being told that chemotherapy involved Abi taking those drugs for 18 months. Furthermore, a cure wasn’t the aim; rather, just stability and management of the tumour. If we agreed, Abi would take vincristine once a week at our local hospital and carboplatin every 4 weeks at the hospital where she had had surgery. To give her those drugs intravenously, Abi would need to have a port surgically inserted into her chest. The Oncologist tried to reassure me: “Mr Langston, carboplatin and vincristine are well-studied,” he said. “Abi might experience some side-effects, but they would only be temporary and not severe,” he continued. “Moreover, she will be monitored carefully, so should there be side-effects, we will pick them up quickly and deal with them,” he said, finally.

The Oncologist also told me about other chemotherapy regimens, including an oral protocol called Temozolomide. “The good thing about Temozolomide is Abi could take the drug at home. So it would not be too disruptive,” he enthused. “However, it is not as well researched as carboplatin and vincristine, and that constitutes a risk.”

It all made me feel a bit uneasy. “How about a ‘watch and wait’ approach?” I asked. “That may be plausible for a little while,” he replied. “But I feel that yet more tumour progression is almost inevitable. In which case, waiting too long would be risky.” He paused and gave me a thoughtful look before continuing: “Mr Langston, the consensus among brain tumour specialists is that adjuvant therapies, such as chemotherapy and radiotherapy, are necessary after a second incomplete resection. I think we must act.”

I also asked the Oncologist whether radiotherapy might be an option for Abi. “It was definitely not a conventional approach for young children with low-grade gliomas and there had not been any long-term follow-up. So it will not have a track record of efficacy,” he told me. “We’re reluctant to give radiotherapy to young children because studies have shown that cranial irradiation increases the risks of other cancers and there’s a fear of causing brain damage in a still-developing brain,” He continued. “In the UK, we prefer to wait until a child is, at least, 10-years old before prescribing radiotherapy,” he said. Even so, six weeks of radiotherapy treatment appeared quite attractive compared to 18 months of chemotherapy. Additionally, its aim was a cure and not just management. “I understand your concerns, but should we opt for radiotherapy, is there a chance Abi could receive it?” I asked. “Yes,” came the reply. “We might be willing to send Abi’s case to the review board responsible for sending brain tumour children to the U.S. for treatment with Proton Beam Therapy, one of the newest forms of targeted radiotherapy.” The Oncologist paused, looked at me, then continued: “But please consider my advice,” he said, with an air of caution. “I would prefer Abi to receive a chemotherapy protocol of carboplatin and vincristine.” I felt I should listen to the Oncologist and Abi should begin chemotherapy. After all, the impression I was given was that it gave her the best chance of good health. Of course I’d agree! However, I am forever the pragmatist: “May I have a little time to give it all some thought, and to do some research?” I asked. “Of course,” came the reply. “But don’t take too long. We need to act.”