The tests are finally done, and all the information is back. The repeated Pulmonary Function Test showed that his lung condition is fine. There is some question as to whether or not there is an underlying asthmatic tendency, but they feel the condition is not significant enough to interfere with proceeding. The repeat Kidney Function test showed that with normal hydration, his kidneys are functioning within normal limits, however the implication we were left with was they were at the low end of normal.
The MRI of both femurs still shows the tumor field, but since the PET/CT scan final report said there is no metabolic activity from these areas, the tumor is no longer active. They say it can take weeks and/or months for a tumor to completely disappear. However, the main thing is that the tumors are not active (growing) and haven't showed up elsewhere (no further metastases). His heart function is still normal, too. There is an odd little spot on his right ankle, but they feel it is most likely a repetitive strain injury from the way Tom has modified the way he walks, due to the muscle damage caused by the vincristine. They will have him come back 3 months post transplant for another full body PET/CT scan to follow up on everything.
So, based on all this information, and the team's assessment of Tom's health, the doctors' recommendations were to proceed with the stem cell transplant, at 75% of the normal toxicity that they might use. This scaling back of their approach is because of their concerns about his general health at this point, and in part due to the amount of radiation he received....I'll spare you the details about the drugs and their side effects just now.
Overall, this is very good news. Initially when we arrived here in Calgary nearly two weeks ago, they were somewhat hesitant and were seriously considering recommending not to proceed with the transplant, because it was unclear whether Tom's body would be able to handle the high dose phase. That's why they re-did some of the tests - and as a side benefit, Thomas had another couple of weeks to recuperate.
We have waited for this for a long time: we have been focused on this phase of treatment because it is our sincere prayer that it will be the last treatment Tom will need. It's been a long year for Tom, and for everyone close to him.
Now that it's finally here, I think it's normal to feel apprehensive of the unknowns. We don't know exactly how Tom's body will handle the consolidation round of chemo, but we feel confident in the abilities of the folks at the Children's Hospital to deal with anything that might arise.
Everything in life has its risks.
While there are certain risks of proceeding, they are outweighed by the high risk of recurrence or relapse that are statistically normal with Ewing's Sarcoma, especially in cases like Tom's where the cancer was already metastatic (had spread beyond initial or primary site) at the time of diagnosis.
The transplant is not a guarantee, but there is enough data to suggest that it will significantly improve his chances of "event free survival" (translation: life without cancer). Please God, let that be the case.
Thomas and I, and Drs. Guilcher and Campbell all signed the consent forms today to put the wheels officially in motion.
We have a bit more than 48 hours now before Tom will be admitted: he'll go in Sunday evening and they'll start the hydration and some anti-emetics (anti nausea drugs) through the night. There will be chemotherapy delivered Monday through Friday, and then he will get next Saturday and Sunday as rest days. He may even get a pass out of the hospital for a couple of hours if he's feeling well enough next weekend. And then on the following Monday (May 31) he'll get his stem cells back. More details in posts to follow...and some pics.
Have a happy long weekend everyone - we'll check in with you next week. We're eternally grateful for all your love and support. Happy and safe travels to you all!
TTFN,
Thomas' Mom
