Round 4

Round 4 of Chemo began on June 24th. They did a CT Scan with contrast on Thursday morning when they first arrived to the hospital. The scan shows that the tumor up by his spleen shrunk almost half the size it was previously the other tumor in his lower pelvis shrunk a little but not much. The chemo is obviously doing it's job which is very encouraging. Cody's Mom,Janae, Cody, and his sister, Cheryl, were also able to meet with one of the Surgeons and the Oncologist to get some questions answered since they had not been given a treatment plan. All the information the family knows about DSRCT they have researched and found out on their own and have never really had anything explained except what chemo he would be getting for now. Cody's mom, Janae, has been receiving e-mails from Dr. Hayes-Jordan and Dr. Pete Anderson from MD Anderson Cancer Center in Houston, Texas. They e-mailed her their treatment plan, which is the first time they have been given an entire treatment plan. MD Anderson recommens completing what is called the P6 protocol, which is what Cody is currently getting. After completing the P6 protocol (7 rounds of Chemo) they would like to do Surgery with HIPEC Treatment followed by more chemo, radiation and then 8H9at Memorial Sloan-Kettering Cancer Center in New York.
The family presented the e-mails from the Doctors at MD Anderson and some articles explaining the procedures the Doctors at MD Anderson were recommending to the Surgeon and the Oncologist at Primary Children's. After reading the articles both the Oncologist and Surgeon agreed that the family should go to MD Anderson Cancer Center in Texas to meet with the Doctors there. The doctors are planning on making some calls and consulting with MD Anderson for the remainder of Cody's treatment. Chemo will continue to be done in Salt Lake, surgery will most likely be done in Texas.
Surgery will probably be done about 2 weeks after the 7th round of chemo, depending on when Cody's count come up. HIPEC (Hyperthermic Intraperitoneal Chemotherapy) procedure is only done on DSRCT at MD Anderson Cancer Center. The surgeon (Dr. Hayes-Jordan) surgically removes as much of the tumors as possible and then they administer the HIPEC Treatment. During the HIPEC treatment the surgeon then continuously circulates heated chemo into the abdominal cavity for a maximum of 2 hours in order to try to kill any remaining cancer cells. The entire surgical procedure last 12-15 hours.
8H9 is a radioactive antibody used to attack the tumor cells and is now being used to treat DSRCT at Memorial Sloan-Kettering Cancer Center in New York.
They don't know any more about these two procedures, these are just the basics. They are planning on flying to MD Anderson some time soon to meet with the doctors where they will be given more information. They aren't sure yet when that will be they are waiting to get tests, scans, pathology slides etc. sent over to MD Anderson for review and for the doctors from Salt Lake to talk to to MD Anderson Doctors. They also need to plan their trip around Cody's counts and his chemo so as of now they don't know when the consult with MD Anderson will be.

As far as the 4th round of chemo, Cody received 2 new chemos Etoposide (VP16) and Ifosfamide. Each chemo is given over 1 hour for 5 days so this time he only has the actual chemo running for 2 hours. After chemo he has Mesna which helps to coat and protect the bladder. Mesna is ran over 3 hours and he gets that 3 other times for 15 minutes every few hours. He does have a break between chemo this time but still has to get up every 2 hours to take his anti nausea medication and go to the bathroom. It is very important to make sure he is using the bathroom every 2-3 hours during chemo and they test the PH level twice a day. Chemo is really harsh on your internal organs including the bladder and kidneys which is why they want to make sure he is using the restroom frequently to help flush it out of his system. As long as he tolerates the chemo well they can and have bumped up the chemo 4 hours earlier every day. He is doing very good considering all he is going through. He only got sick the first day but they made some adjustments to his anti nausea medications so the nausea has been better the last couple of days. He is still really tired from the chemo and does get dizzy and nauseated but so far seems to be doing really well.
Even though there still is not a set plan with a timeline the family feels a lot more confident knowing that there is a treatment plan and Salt Lake will be working with the Doctors at MD Anderson to get the best possible treatment options out there to help Cody fight off the cancer. Hopefully in the next couple of months they will have more answers as of when surgery will be done but still it all depends on Cody and his blood counts. They can't do surgery unless his counts are high enough so for now they will finish up the P6 protocol in Salt Lake (probably 3 more rounds)and work on getting over to MD Anderson to meet with the Doctors there.

A special thank you to Aunt Cindy and Uncle Dale who have brought dinner and snacks to Cody and provided a place to sleep for family members traveling from out of town to visit Cody in the hospital. You guys are great!!