On August 15, 2024 Tom had his three month MRI and it revealed a 1.2 cm mass at the site of his original brain tumor. This mass was not detectable at his previous scan in May. It is his doctors’ professional opinion that this is a recurrence of his glioblastoma (GBM) brain tumor and they are united in their advice that we remove it as soon as possible.
His oncologist is recommending a LITT procedure. From Mdanderson.com:
“Laser interstitial thermal therapy (LITT) is an emerging technique to treat primary and metastatic brain tumors that can be hard to reach with conventional surgery. LITT is performed by implanting a laser catheter into the tumor and heating it to temperatures high enough to kill the tumor.
The catheter is implanted using advanced computer imaging techniques. The laser is guided through the catheter with real-time MRI, allowing neurosurgeons to limit thermal energy delivery only to the tumor. Most patients can go home the day after treatment and can quickly return to normal activities.
Laser interstitial thermal therapy is minimally invasive. It typically requires only a 2-millimeter incision in the scalp, and takes only a few minutes to perform.”
You can read a lot more about the procedure and its other applications here:
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/laser-interstitial-thermal-therapy
On Wednesday 8/21 we met with a surgeon through the Oregon Clinic (inside Providence St. Vincent clinic) who will perform the procedure. Today we received a confirmed surgery date of Friday 8/30. His surgeon is experienced and works closely with Tom’s oncologist. We love that this will be lower risk and a lot less invasive than the craniotomy that Tom underwent 8 years ago. At most we expect an overnight in the hospital and a quick return to normal activity. His surgeon shared that he typically does more complicated procedures and Tom’s tumor placement is in an easy spot and has a good round margin. His scan last week showed that the tumor is not collecting a lot of blood at this time which is a favorable indicator. At the same time of the laser procedure, they will also take a biopsy of the tumor for testing. We need to confirm what type of tumor it is and what genetic markers it had.
In 2016, Tom’s tumor had the IDH mutation and was MGMT methylated which made it more receptive to treatment, particularly chemo. We are hopeful that if it is the same tumor it will also have these same treatment receptive markers. Since 2016, additional genetic markers receptive to treatment have been identified and we hope to see if Tom has any of these additional markers that will help him fight the tumor. Doing this particular procedure will also help breach the blood barrier in his brain, allowing potential treatment. We are considering immunotherapy if we can get it in time to be effective prior to his surgery. It may also be considered after. There is no standard treatment for a recurring GBM, so options could include more chemo and radiation, Optune, immunotherapy or other drugs and trials pending what we find with the pathology.
As you may recall Tom’s neuro oncology team moved from OHSU to Providence a few years ago. We have reached out to OHSU as a second consult because Tom’s original surgeon is still there but we have not been able to get a date to meet with him until about another two weeks. It would be our hope that Tom will have already undergone his surgery at Providence by then or shortly after. We feel very confident in this plan to move forward without the second consult given the urgency of addressing this. We have also adopted Dr. Jerry, Gauri and their kids into our family. Despite their move to Oklahoma we keep in touch and Dr. Jerry has been in regular contact with us since we first got the news and always provides his valuable feedback. He likes and supports our plan.
It’s important to note that this tumor was caught early and was asymptomatic like last time. It is much smaller than it was 8 years ago and not in a critical area of the brain. We expect a great surgical outcome. Tom is in better health than he was 8 years ago. We have a strong team of providers around us. There are more treatment options and better technology. It is hard and shocking to be back here again, but we remain optimistic. Fighting this disease has been a marathon, but at times like now we must sprint. We are thankful our team of providers is treating it with the urgency it deserves. We all know that Tom is special, an outlier. He has defied the statistics before and we believe he can do it again.
Thanks for your love and support,
Jess and Tom
