Progression vs. Pseudoprogression

Well, today's MRI showed that something was there. The MRI from March showed a shocking lack of tumor, but this one showed something in the tumor bed that was not there before. It is about 1cm x1cm and the radiologist called it a progression of his original tumor (meaning that she thinks it's growing again). Our oncologists, however, were not so sure that this was true progression but rather it could be something they call pseudoprogression. Pseudoprogression looks and acts like a progressing tumor, but it is actually due to necrosis (death of cells) and other inflammation that is attributed to radiation and chemo. Pseudoprogression would remain stable in size and could eventually go away. It is often seen around this time after radiation, and the fact that the last MRI was so clean makes them suspect that this is pseudo even more. Joseph does not have any signs or symptoms due to the mass that is there, but this does not help in the diagnosis either way because pseudoprogressions can also cause symptoms.

So, our team is going to the tumor board next Wednesday (the group of radiologists, neurosurgeons, and oncologists) to discuss his case. It sounds weird and non-scientific, but they are going to come up with a consensus on whether to call this true progression or not. So we have to wait until next week to see what the other opinions are. Joe will continue to take his current meds until it is officially a true progression.

Obviously, we are rooting hard for a pseudoprogression diagnosis. Unfortunately the only way to know for sure is another biopsy, but that has not been discussed yet and I doubt they would recommend it. My best guess as to what the course of action will be is that they will have him continue Tarceva and then come back in 4 weeks for another MRI, but I'm guessing.

What does this mean for Joe? If it is pseudo, then he will continue Tarceva and we'll go on like we didn't go through this horrible day. If it is true progression then he will stop this trial and we will move on to a new one. We have some other trials already in mind if this should come up.

So we're in limbo for the next week and probably for the next month. Please pray for the meeting next week, that the diagnosis would be obvious to everyone. Please pray for strength and peace for us as we are feeling frustrated, angry, and helpless. And continue to pray for healing for Joseph.

After Joe had his port accessed (it took five people to hold him down) he was great and did not complain or cry too much. He actually hugged all his doctors and played a lot with Aunt Jennifer today while we were talking to the doctors. We even had time in today's schedule for a visit to the Children's Museum with Jen, WK, and her Nana. We will be coming home tomorrow after PT/OT appointments. Thanks for all your prayers.