It's not the hand you are dealt, but how you play your cards.
Treatment
The effort to overcome this disease is always a collaborative effort among many. There are three physicians however, that have been entrenched in this last battle: Dr. Twist, Dr. Koltai and Dr. Donaldson. All three physicians are very strong professionals but beyond medicine, they are wonderful people. There were countless times in our journey when we were put at ease with answers to questions; schedules were arranged to accommodate the urgency of our situation; but most important of all, every possible effort was made so that Nick was kept as comfortable as possible. Thank you.
Dr. Peter Koltai came on board to biopsy and surgically remove the sarcoma, For those not familiar with the maxillary sinus area, the way to find it is to put a finger in your mouth, touch the top right back teeth – the palate adjacent to these two teeth, through the palate above is the maxillary sinus. The tumor had grown around the bone above the teeth and was protruding through the palate. See picture on right.
The surgery was a
success as the tumor and margins were removed. The process of getting
as much of the tumor as possible involves sending slides off to
pathology of the surrounding areas to determine how much to remove.
Overall, what was might be left would be treated with radiation
therapy.
The video below shows
graphic pictures and video of the tumor site pre and post surgery. One
of the slides shows the roof of the mouth closed up. This was Dr.
Koltai's amazing effort to completely close the area where the tumor
had been removed by stretching the palate. Unfortunately, this did not
hold and tore slightly. Nick went in for a second procedure to do some
repair. The end result is that he will have a hole in the roof of his
mouth that will be covered by a retainer like device (obturator). The
movie shows going into the maxillary sinus through the roof of his
mouth.
Nick underwent radiation therapy twice a day for 4 weeks and 4 days. The amount of radiation delivered to the location of the tumor was 5,500 rads. Intensity-modulated radiation therapy (IMRT) is method of radiotherapy that utilizes computer-controlled x-ray accelerators to deliver precise radiation doses to a malignant tumor. IMRT conforms the radiation dose more precisely to the three-dimensional (3-D) shape of the tumor by controlling (modulating) the intensity of the radiation beam. IMRT also allows higher radiation doses to be focused to regions within the tumor while minimizing the dose to surrounding normal critical structures.
Post Radiation 2003
During Radiation 2009
Dr. Donaldson led the
team to plan treatment for Nick and as always took a personal interest
in making sure Nick was comfortable along the way. Treatment is planned
by using 3-D computed tomography (CT) images in conjunction with
computerized dose calculations to determine the dose intensity pattern
that will best conform to the tumor shape.
In Nick’s case planning treatment was complex because of several constraints: (1) They needed to take into account the overlap from the radiation field that was used to treat his rhabdomyosarcoma 6 years ago. (2) They needed to stay away from his eye. (3) They needed to consider his pattern of nose bleeds as a result of the last treatment. (4) The needed to identify the location of the tumor before and after it was removed. (5) They needed a treatment plan that eradicated any microscopic evidence of tumor and preserved quality of life in the future.
