Heavy Drinkers, Radiologists and Blurry CT Scansby Chris Battle, survivor on September 7, 2011
This article is cross posted from The Kidney Cancer Chronicles.
I know what you’re thinking. Chris Battle is dead. Josie ate him. That cute little two-year-old cooked him up with some fava beans and a nice Chianti. Well, relax. While my child may indeed be a cannibal, I am still bigger than she is. So why the long silence? I don’t actually have a good excuse. Life has gotten in the way. Which, in our business, is a good thing I suppose. I’ve been traveling to remote Michigan to visit Dena’s folks before winter buries them under a pitiless crust of ice. I’ve been getting Kate ready for her first day in First Grade. I’ve been playing some golf. Evidently my clients still expect me to “show up” for work. (Whatever.) Oh, and I’ve also been religiously undergoing my MDX-1106 infusions at Johns Hopkins. Every other Thursday: Blood tests, lab pokings, a little probing (figuratively and literally) from Dr. Hammers and then up to the Infusion Center for two hours of an IV drip and close monitoring. (An Infusion Center, you ask? It’s a more politically correct term for what used to be called Chemo Wards. Which sounds vaguely evil. Plus, as Dena likes to demurely point out: He’s not getting chemo, dammit! )
I’m pleased to report that I’ve got little to report over the past month. MDX-1106 continues to be a remarkably agreeable drug. Not like bourbon or anything, but compared to IL-2 or Sutent it ranks a reasonable wine. Well, maybe a cheap wine. Boone’s Farm or some other syrupy concoction you tried to feed your high school girlfriend. But still, it’s not the bathtub gin that Sutent could prove to be. The worst of the side effects continues to be skin complications. Primarily the aggressive rash on my shins and calves. We received the pathology results from the punch biopsy (translation: chunk of flesh) they took from my left calf. In its near entirety, it read: This is not renal cell carcinoma.
Which understandably provoked Dr. Hammers: “We need a pathology report for this ?” he asked. “It would have been helpful if they had told us what it was, not what it wasn’t. We already know what it’s not.”
Right on, brother.
Truth be told, however, I’m less concerned at the moment with pathology reports than radiology reports. Thursday I will be getting a new one. Cycle 3 of the clinical trial has concluded, and Thursday I go in for a CT scan. There is some unacknowledged anxiety in the Battle household this week. (Move on, there is nothing to see here.) This scan will likely determine whether or not I continue on the clinical trial. If the scans show tumor progression, I will be tossed out like a cheap purse. If they show stability or better, I will stay on the trial. My preference is the latter. Not only for the obvious reason (I get to live), but also because the whole idea of starting another treatment regimen is a bit wearisome. Aren’t there just some really good vitamins or something? Although … it’s not so wearisome if it actually works. I’ve got my eye on one alternative therapy in particular: coffee enemas. According to an alternative medicine website, this “unorthodox” cancer treatment dates back to the time of the Egyptian pharaohs who retained their own “guardians of the anus” to administer the enemas. (There is so much that shall go unsaid here.)
Dena and I approach Thursday’s CT scan with a new level of apprehension, due to some things we’ve discovered about radiologists. Primarily: They drink heavily. That’s the only conclusion we were able to draw after the results of our last scans. The initial radiology report we received showed growth across the board among the mets in my lungs and also indicated entirely new lymph node involvement in the left supraclavicular node measuring two centimeters. This was rather disappointing.
Clinical trials, however, handily come with spare radiologists to provide secondary readings of CT scans. It’s like those extra buttons you find in the inside coat pocket of the sports jacket you just bought. Never know when you might need one. The secondary reading of my CT scan showed far less growth and actually some tumor shrinkage. Oh, and no mention of the new tumor in the lymphatic system. Score one for the buttons. (Or, buh-ons, as my Jersey friends at work would say.)
The differences in the readings measured in centimeters, not millimeters. So we are not talking about statistically insignificant divergences here. (There will always be some degree of divergence, as CT scans are thinly sliced crosssectional photos of your insides. These photo slices are then pieced back together like a paper mach`e puppet by a computer. A few millimeters here, a few there, mean little.)
So which radiology report was the correct one? Well, I choose door No. 2. Unfortunately, I’m not the Decider, to quote our former president. My question, then, is what kind of strategery is in place to make a reasonable judgment about whether I should be allowed to continue on the trial should the radiologist’s report come back with a negative reading?
This isn’t an idle question. A recent study published by an oncology team at Sloan Kettering concluded that CT scans to measure lung tumors can be unreliable, resulting in stopping treatments or clinical trials prematurely. In the study, a sample of lung cancer patients agreed to take two CT scans minutes apart. These scans were then given to radiologists who had no idea that the scans had been taken minutes apart – meaning that it would be impossible for the tumors to have grown or shrunk to a statistically significant degree. These radiologists compared the matching CT scans. According to the their conclusions, these magic tumors had changed considerably in the blink of an eye – ranging from 23 percent shrinkage to 31 percent growth.
This is unnerving. Should my radiologist determine that my tumors have grown by such percentages (even if they haven’t grown at all), I will be dropped from the trial.
So, guys: No drinking Wednesday night. And no hair of the dog Thursday morning. I’m counting on you.