Monday, August 21, 2017
Y'all know I've been yelling about the improved outcomes patients can attain for brain mets when targeted radiation (SRS or Gamma knife) is paired WITH immunotherapy: Here's just a few of my rants and LOTS of data: Radiation and Immunotherapy...better together!
Now there's this:
Radiation and PD-1 inhibition: Favorable outcomes after brain-directed radiation. Pike, Bang, Ott, et al. Radiother Oncol. 2017 Jun 26.
Patients with metastatic melanoma, renal cell carcinoma (RCC) and non-small cell lung cancer (NSCLC) are increasingly treated with immune checkpoint blockade targeting the programed death (PD)-1 receptor, often with palliative radiation therapy. Outcome data are limited in this population. We retrospectively reviewed consecutive patients with metastatic NSCLC, melanoma, and RCC who received radiation and anti-PD-1 therapy at four centers.
We identified 137 patients who received radiation and PD-1 inhibition. Median survival from first PD-1 therapy was 192, 394, and 121 days for NSCLC, melanoma, and RCC patients. Among 59 patients who received radiation following the start of PD-1 blockade, 25 continued to receive PD-1 inhibition for a median of 179days and survived for a median of 238 additional days. Median survival following first course of radiation for brain metastases was 634 days. Melanoma patients received brain directed radiation relatively less frequently following the start of PD-1 inhibitor treatment.
Incorporation of palliative radiation does not preclude favorable outcomes in patients treated with PD-1 inhibitors; patients irradiated after the start of PD-1 inhibition can remain on therapy and demonstrate prolonged survival. Of note, patients irradiated for brain metastases demonstrate favorable outcomes compared with historical controls.
It is still not easy nor perfect....but it's something!!! - c
Saturday, August 19, 2017
My OWN Tessuti Annie Tunic!! With a different slow fashion approach to the front yoke!
|I was so excited when making this top for Ruthie!!! In fact, I enjoyed it so much that I began to formulate great plans for my own!|
To back up a step ~ I discovered the writings of Pearl Buck in my hometown library around the age of 12. Voracious reading of all her novels took me far away from my own surroundings to a place of beauty, rice paddies, pagodas, chop sticks, intricately embroidered kimonos. Through her stories I could live in a world and culture completely foreign to anything I had ever known. I became fascinated with all things of the Orient. When my sisters were both stationed in Japan, they sent me a beautiful kimono and figurines I treasure still. When I discovered Sashiko embroidery I was in love!!! Sashiko, literally - 'little stabs', is an ancient embroidery style, originally used to mend, reinforce, quilt blankets, embellish and winterize garments for warmth and thriftiness, for Japanese fishermen and their families. I think it is incredibly lovely. This tutorial on The Thread from Fabric-Store.com and this amazing blog, Radiant Home Studio, by Sara Curtis, which is awesome in many ways, are particularly helpful and inspiring when thinking about tackling a Sashiko project.
|This photo of a Sashiko quilt Sara posted on her blog (link above), is sooooooo amazing!! It is titled: Sashiko by volunteers, 2012, Textile Museum of Canada. Isn't it beautiful??? I'm going to make one myself when I grow up!!!|
|This fabric did not necessitate a lining...but still... No. Ugly. Insides.|
|Easy and pretty!!|
|Not as zen as I probably should be!!! But, I'll take joyful any day!|
|I lurve it!!|
Friday, August 18, 2017
In September of 2013, I was blessed to experience a beautiful trip through Spain. It began with a trip to Tampa for my 3 month post nivo trial follow-up visit. But, with clear scans and the promise of no doctors for 6 months - we were off - flying from Tampa to JFK to Madrid. Finding the bus to Atocha was managed - by me and MY Spanish!!! - culminating in our arriving at the best little B and B, Lope de Vega, run by the sweetest young couple.
|We fell into the Spanish tradition of half raciones with 'dos canas' very happily!! Pulpo a la gallega (octopus and potatoes, B's fav!), toastados with gambas al ajillo, and patatas bravas! Followed by strolls through Plaza del Sol and Plaza Mayor.|
Next morning, after a run in the Parque de el Retiro, which reminded me more of green spaces in France than Britain or the US, with sculpted trees, fountains, fine graveled paths filled with runners, bikers and dog walkers - and another breakfast with Aussies who, "though they dove deeper, came up dryer!!!" - we were off fabric shopping. I had not sewn very much at that point, but I wanted to get something beautiful for Ruthie. And at Ribes and Casals, there it was, a lovely Chanel-like tweed with brilliant pinks that was perfect!! From my journal that day: "B was all for it and got the attention of a guy who thought I knew all about sewing AND Spanish - both completely untrue!!!. B persevered. I did my best to answer the many questions flying back and forth - 'quantos suficiente' and 'tejidos por pocket' (which I took to mean lining!!) all in rapid fire Castilian Spanish with a bit of a slur- not exactly the Spanish dialect I am used to!!! Questions about Libya and Syria came up! Oh, Lord!! B still managing!!! Suddenly, a final question left us stumped and lost - as the entire shop came to a stop and all eyes turned to us. An older lady ahead of us in the check out line repeated the question more slowly. "¿Por qué estás comprando tela aquí?" B, thinking quickly replied, "Porque no podemos conseguir tejido de esta belleza y calidad en casa!" Big smiles all around. And, thankfully, all involved returned their attention to their own affairs!!!"
|(THIS! The dress Ruthie made from the fabric!!!)|
We spent the afternoon wandering through Reiana Sofia ~ Picasso's Guernica!!! The Prado ~ Velazquez (especially Las Hilanderas and Las Meninas)!!! Leaving me simultaneously filled with wonder inspired by the incredible beauty, intelligence, talent and horror of man.
|A short walk to the marvelous madness that is the Market of San Miguel!!!|
|Verms!!!! Well, technically - eels!! Angulas! (FYI - they tasted like tough spaghetti with garlic sauce.) Chorizo! Croquetas! Gildas!|
|When in Rome!! Or Spain!!!|
|Seriously, plazas, restaurant displays, and nightly adventures are a beautiful way of life!!|
Blech!!! Mr. Steves, you are most confused or have a serious typo in your book. The barrels are cider. It was okay. Just not quite what I expected. Live and learn! I adore txakoli!! Cider...despite its romantic barrels...not as much!
|Next day, after another beach run, we took a walk to experience 'Barri Gotic', a metro ride to Sagrada Familia (Incredible!!!), and the metro back to Barceloneta. The fish displays outside the restaurants reminded me of those in Greece.|
|Back on the train - on our way to Sevilla. From the train windows there were garden plots, vineyards - giving way to sandy grey soil with olive trees and terraced fields. In two hours more, acres and acres of sunflowers!!! Followed by reddish fields with more green, fruit trees, and vineyards. After a warm walk...we found the - Street??? Path?? Corridor??? that led to our hotel. Our requisite evening paseo took us down Constitucion and back, with a giant church, amazing facades, sangria, chipironies a la plancha and espinacas con garbanzos for supper!!|
Next morning, I slept in, but B brought me hot chocolate and churros for breakfast. A walk to Mercado Arenal brought us: pale green zucchini, pears of all shapes and sizes! Fish, lobsters, cigaretellos, langostines AND shrimp!!! Razor clams, snails, dorado with their golden noses, hake, chicken, eggs, and ham!! More espinacas con garbanzos and my first experience with ensaladilla Rusa!!! YUM!!! On to the Cathedral, though by now B was rather tired of "God on a stick" and a bit like a well behaved though sighing 4 year old. But, I had a plan!!! Here you could climb 330 feet up in the bell tower...to take pictures!!! So. We did! More wandering, admiring the amazing tile work throughout the city and dinner at what may have been the best restaurant of the trip: El Jardin de las Tapas. Barbadillo Blanco!!! Two different types of gazpacho, one lighter with bits of pepper, onion and herbs on the side to add as you wish and another richer version with ham (salmorejo). Lamb with gravy and potatoes. Peppers stuffed with merluza (hake). Followed by a Flamenco show down the street. B was a happy man!!!
|After our morning run on a Sunday, we meandered down to the river.|
|I would live in the blue house!!!|
|After exploring the lovely streets and neighborhoods along the river, we landed at Taberna Miami!! Oh my goodness!! Here you need an appetite for crazy as well as delicious food. I was befriended (as are many) by the exuberant owner and filled to the top with my Frito Pescado (bright red shrimp, a whole little flounder, big pieces of fried cod, pieces of what must have been merluza, calamari rings, topped with what at first appeared to be thin shreds of fried onion - but on closer inspection tiny little eyes were visible - angulas - delicious!!) B's oxtails were amazing. And B's increasingly proficient Spanish won him this story from the proprietor: "I've worked hard in life, but I have played hard as well. Take the road to adventure. In doing so, along the way, the women have been the best." In the end, B was not sure if he was encouraging a lech or if, in fact, women are simply of 'mi corazon'!|
|An early breakfast (check the pic in the mirror) before heading to the taxi stand. In much of Spain, bars (where you may find a group of older ladies, families with children....not your usual "bar"!!!) from the night prior, are the breakfast places of the morning. Cafe con leche and pan con tomate. Usually with salt, pepper, and olive oil to add as you like. All a growing girl needs! Off at a mad pace in the taxi with the usual white knuckle, in and out of traffic drive to the train station. Jovial young gent, with a love of 90's pop music...plus Kansas, Dust in the Wind...judging by the radio, was our driver. Such an efficient drive to the station gave us time to review our plans for Granada. Our 2 hour train ride (its duration due mostly to 11 stops along the way) showed arid fields with drying sunflowers. Others were plowed or newly mown. Occasional impressive haciendas with white stucco walls, red Spanish tiled roofs. Olive groves as far as the eye could see. Landing at the smallest (and sadly, dirtiest) train station of the trip, we found our hotel rather easily and discovered, when grabbing a bit of lunch at the last moment before siesta, that Granada actually embraces the premise of 'tapas' as a "free plate" - an appetizer you get with your beverage - much more seriously than the rest of Spain. Elsewhere you may get a little bowl with 5 olives with your beer. Not bad!! But here, we were given a good sized bowl of chicken cooked with peppers and potatoes!! Really delicious!|
|Incredible tile work. Gardens. Fountains.|
|Reportedly painted in brilliant colors years ago...still unbelievably beautiful.|
|In awe of all that we had seen, we wandered back on foot. Because we never mind walking, and in the chaos of arrival, we didn't see any way to find the bus we were supposed to return on! Discovered camarones al pil pil for dinner.|
|Modern art. We saw many lovely examples of 'artful' graffiti!! Next morning, walked back to the train station. Now knowing the lay of the land, we realized it was not far from our hotel.|