Choices, Choices, Choices

Last friday, I had my second appointment with my doctors, and they discussed their findings and the two treatment options. The CT-scan and PET-scan both showed that nothing has gotten worse since my scans in Tokyo, and also that it has not spread beyond my lymph system and spleen. Therefore, there are two ways they can treat me. ABVD, named for the four toxic chemicals they will pump through my body, or Stanford V, named for the five toxic chemicals they will pump through my body, and the institution that developed it.

ABVD is what has been used for Hodgkin's for the last 20 or more years, and is pretty tried and true. It will be 6 courses, lasting a month each, injected every 2 weeks. The side affects are hair loss, nausea, general crappieness, etc. in the short term, and possible heart and lung scarring in the long term.

Stanford V is a newer treatment developed by stanford, but it too has been around for a while. But because of the relative rarity of Hodgkin's, it's still in trails. The main benefit of Stanford V is that it takes only half the time of ABVD. It would be 3 months, with injections every week. The short term side affects are about the same as ABVD, but one of the ingredients is something called nitrogen mustard, a derivative of mustard gas. It was one of the first chemicals used for cancer treatment, but has long since been replaced with others. Now it is back, but in much lower doses. Some of the side affects are sterility and a possible reassurance of other forms of cancer. In the old days, this would be about a 15% chance. With the Standford V, my doctors have said that it's probably 1 to 2%, and sterility is also uncommon. Also, with Stanford V, less of the chemicals that could cause heart and lung scarring are used in lower doses.

The nitrogen mustards sound pretty ugly, but really, it's a pretty close call. ABVD has been successfully used for a long time, but its 6 months and has a risk of scarring, while Stanford V is much quicker and has a lower risk of heart and lung scarring, but has a tiny chance of causing a secondary cancer.

I am worried about the possible heart or lung problems, and I like the 3 months vs. 6 months of the Stanford V, but I don't like the 1 to 2% re-occurance rate vs. .1% of ABVD. So right now I'm still trying to decide between the two. Treatment will probably start friday.