The list of treatment options for treating metastatic neuroendocrine tumors is short, and other than complete removal with surgery, each has a low probability of success. In case the new treatment didn't work, Mat decided to revisit the possibility of removing the cancer by taking out portions of his liver (called resection).
He met with Dr. Tanabe at MGH on July 18, expecting to hear that resection was not an option. Instead, he said yes ... with the condition that Mat's cancer had not grown more than 25 percent since the last MRI.
Mat had tests almost every day this week to check on the cancer growth. We found out on Friday that Mat had a "minor response" to the streptozocin and adriamycin. Although it did not hit the "home run" we're looking for (and that Dr. Ryan keeps talking about -- I think "home run" here may be a euphemism for "miracle") -- it kept the cancer stable, and thus operable!
Although Dr. Tanabe is willing to perform the surgery, one of the things Mat likes about Dr. Tanabe is that he is realistic. Other surgeons he's talked to have been overly optimistic about the probability of a cure with surgery, and lost some credibility with Mat and Dr. Ryan as a result. Dr. Tanabe is managing expectations: He told Mat that he thinks the probability of five-year survival with surgery is 25 percent -- give or take 25 percent. I'm hoping he's a little too pessimistic.
The plan is for Dr. Tanabe to remove 70 percent of Mat's liver -- the entire right lobe and much of the left lobe, leaving the center. The liver will regenerate within a couple of months. This is very hard work, so Dr. Tanabe expects Mat to be very, very tired. The surgery will be performed within the next 2-3 weeks -- any longer, and it may be too late.
It is possible that when Dr. Tanabe examines Mat's liver during surgery he will find more cancer than is shown on the MRIs and CT scans. If that is the case, and if he doesn't think he can remove 99 percent of the cancer, he will not perform the resection. Does everyone know what to fast and pray for? Good.
Here's a web page with Dr. Tanabe's picture and quite impressive resume: http://www.mgh.harvard.edu/cancer/care/adult/melanoma/team_clinician.asp?id=258
We'll have a date for the surgery on Monday. I'll keep you posted.