Solving a Puzzle

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Greg Raver-Lampman

Jillian Sanderl couldn’t stand to see her baby, Landon, in pain. Blessed with a wry grin and an infectious giggle, he loved nothing more than snuggling up to Jillian and his grandparents, John and Patti Sanderl.

But at 10 months of age, Landon began to run fevers and vomit. He was inconsolable, clearly in agony.

LandonSanderl“I’d honestly never heard him cry like that before,” said Jillian. “Not like that.”

Doctors found an ear infection, but medicine failed to stop the pain. During a diagnostic workup to find the cause of the pain, a CT scan revealed a brain tumor the size of a golf ball at the base of Landon’s brain.

“When you hear the words ‘brain tumor,’ it just strikes terror in you,” Jillian said.

Within minutes of the diagnosis, Landon and Jillian were in a mobile ICU, rushing to CHKD. Less than an hour after they arrived in the Emergency Center, CHKD neurosurgeon Jerry Penix took Landon into surgery to implant a temporary, external shunt to drain trapped spinal fluid building up in the ventricles of Landon’s brain.

After the surgery, Dr. Penix told Jillian and her parents about the tumor, starkly etched on an MRI taken at CHKD.

“Are you going to do a biopsy to see if it’s cancerous?” John asked the surgeon.

“There’s no reason to do that,” Dr. Penix told him. “Whether it’s benign or cancerous, we have to get it out.”

Six days later, Dr. Penix’s partner, neuro-surgeon Joe Dilustro, went into surgery to remove the tumor, which was located near the brainstem, encasing nerves and spreading through Landon’s brain like the roots of a tree. During the eight-hour surgery, Dr. Dilustro removed more than 90 percent of the tumor.

A few days later, pathology determined that the tumor was a malignant ependymoma, a tumor so resistant to cancer-killing drugs that they sometimes grow during chemotherapy.

In Landon’s case, pediatric oncologist Herb Bevan decided Landon’s tumor required a relatively new, hyper-aggressive chemotherapy protocol. The new therapy would first require stem cell rescue, where doctors remove cells from the blood that can help regenerate bone marrow ravaged by chemotherapy.

As Dr. Bevan explained, oncologists normally must limit the amount of chemotherapy so they don’t kill bone marrow that churns out infection-fighting white blood cells. “Chemotherapy can beat up on the bone marrow so badly that the patient can die from infection,” he said.

Harvesting stem cells is like “taking flower seeds out of the garden, then spreading Round-Up to kill everything before seeds can be planted again,” Dr. Bevan said.

Once his stem cells were harvested, Landon underwent five rounds of chemotherapy, each lasting three to four weeks. Each time he was confined to the hospital. Jillian, her parents, friends and church members took turns staying in Landon’s room every night. Nurses, child life specialists and therapists worked to keep Landon entertained.

“One nurse asked me if I wanted water or anything,” Jillian recalled. “She said, ‘I’m not only here for Landon, I’m here for you as well.’”

LandonSanderl2Over the course of several months, Landon required more than a dozen surgeries, including one to implant a permanent, internal shunt to draw excess spinal fluid from Landon’s brain to his abdominal cavity.

Landon returned home for a few days between each chemotherapy session. Before the final dose of chemo, Dr. Bevan gave Landon a transfusion of his harvested stem cells. His bone marrow responded and his white blood cell count increased.

The Sanderls were on edge, fearing that the last round would be more agonizing, but thanks to the stem cell rescue, it was far less traumatic than they feared.

Even better, the aggressive chemotherapy appeared to have killed, or at least stopped the growth of, the small amount of tumor that had been left behind.

Landon faced numerous roadblocks to recovery. Because of nerve damage, he was unable to eat for 10 months. A seemingly unrelated spinal problem made it necessary for him to wear a neck brace to support his head. Today, his neck is stronger and the brace is coming off gradually. And he eats voraciously.

At 3½, Landon is an energetic and polite toddler who loves snapping together puzzles and playing with his favorite trucks. When visitors come, he shows off his impressive vocabulary and peppers them with questions.

“Do you like SpongeBob?” he asks, followed by, “Wanna play?” and a polite, “Do you want a snack?”

As Landon scurries around, trying to stand on his head, flopping in chairs and clowning, his mom and grandparents smile.

They know that, as in most cancer cases, nobody can say for sure what the future holds.

“Whatever happens,” Jillian said, “the fact that Landon is here today is a miracle.”

Drs. Penix and Dilustro practice with CHKD Surgical Group’s neurosurgery practice. Dr. Bevan practices with Children’s Specialty Group PLLC at CHKD.

This story was featured in the second quarter 2008 issue of KidStuff, a publication of Children's Hospital of The King's Daughters.

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