Consultation with Dr. Marshall

My sister Grace had heard about Dr. Marshall through a business contact. He is a famous professor/oncologist at Georgetown's Lombardi Cancer Center. Georgetown is about 45 minutes from my parent's place so it is one of the "local" oncologist options. In the morning prior to leaving, my mother had a terrible sharp pain in her stomach. I was worried she wouldn't make it but she took some Malox and somehow she found the strength to go with us. We were anxious for her to come with us because we didn't want to miss this opportunity to talk to Dr. Marshall.

Dr. Marshall and his assistant Dr. Amy Rankin were extremely nice. They made us feel very well taken care of which was a nice contrast to relying on the surgeons. Dr. Marshall was very concerned about my Mother's condition and prescribed some IV fluids. A blood test revealed her potassium was very low so they also infused some potassium. He prescribed a lot of medication to help my mother feel better including fentanyl patches (better to control pain than using oral meds if you are vomiting), potassium supplements, an anti-nausea steroid, etc. It's a good thing my mother went to see Dr. Marshall that day because she was really dehydrated and the IV fluids made her feel a lot better. One advantage of seeing an oncologist early on after the Whipple is that you have somebody who can prescribe meds and take care of you. We really liked Dr. Marshall because he paid a lot of attention to my mother's comfort.

We also discussed his take on adjuvant therapy. His philosophy boils down to starting with chemotherapy using Gemcitabine. Radiation would only possibly come later on after several months. He also believes in long term maintenance using a low dose of some medication (I forget which). To support his approach he referred to the European study which showed that radiation was of questionable benefit and that chemotherapy alone proved superior. The Hopkins doctors had discounted this study saying that the radiation may not have been applied effectively. Dr. Marshall also believes that it is more important to focus on treating "systemically" to prevent distant metastasis first rather than treating locally to prevent local advance. The reason he presented is that the distant metastases are what kill you. His take on the Hopkins approach was that they had a very strong radiation oncology department so this explains why it would figure prominently in the treatment plan. We also asked him about his opinion on the Virginia Mason protocol. He said that it was a single institution study that hadn't been verified and that there was a tradeoff with the significantly higher toxicity.

So the plot thickened now with three major options on the table:

• Hopkins approach: radiation w/ Xeloda followed by chemo w/ Gemcitabine (maybe Tarceva)
• Georgetown approach: chemo w/ Gemcitabine maybe followed later with radiation.
• Virginia Mason approach: radiation w/ 5FU/Cisplatin/Interferon followed by Gemcitabine (maybe Erbitux)

BTW - the cafeteria at Georgetown was excellent. It's across from the Lombardi Center.