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Treatment Phase One

Last week I was fitted out for a radiation mask, which is actually more of a guide than a mask. There was a plastic mesh that they dipped in hot water to soften it, then shape it around my face, while my head was being held in a certain position and a CT scan was performed. Markers were put on the "mask" while the scan was made. The idea, as far as I understand it, was to make sure they had my head aligned in a way that allows them to aim the radiation right at the spot where the tumor used to be (and the likeliest place for it to return) while avoiding as much healthy tissue as possible. The mask will allow them to put my head back into the exact same position every time I receive a dose of radiation. All that starts next Monday, which will actually be a trial run to affirm that they have everything aligned correctly. Application of radiation begins on Tuesday, and will happen five days a week for six weeks, ending in late February.

There's a choice these days between photon and proton radiation. Photon is the older, more established technology, and it's apparently very similar to X-ray radiation. Proton has been much harder to get until recently, because it requires a cyclotron. Seattle (specifically Northwest Hospital) just got one of the machines within the last year or two. My radiation oncologist, Dr Halasz, has mostly used photon, and she said there's no clinical evidence yet of an advantage between the two technologies. All the evidence is about the older, more established technology, not surprisingly. The theoretical advantage of proton is that it leaves its dose of radiation only in the place where it stops, whereas photon leaves a dose going in and another dose coming out. So theoretically proton would do less damage to healthy tissue surrounding the target area. But the oncologists emphasized the lack of data about proton, and Northwest Hospital is not as close to me as UW Medical Center, where my oncologists are, so I chose to go with photon.

Simultaneously with the radiation, but seven days a week instead of five, I'll be taking a chemo drug called Temodar, which is the brand name of Temozolomide. This is taken orally, not intravenously. One of the good pieces of news I've received since the horrible news came down is that my MGMT gene is methylated. What this means in practical terms is that my body won't try to prevent the Temodar from killing cancer cells. Apparently unmethylated people have an enzyme that repairs the cancer cells the chemo is trying to destroy. The oncology nurse told me this gives me only a slight advantage over unmethylated folks, probably only months, not years, increase in the statistical probabilities of survival. Still, I'll take the edge, given the option. With any luck, it will also mean that my experience of the chemo will be less horrible. On the other hand, a lot of people have insisted that Temodar is, indeed, better tolerated than other forms of chemo, in terms of side effects. Fingers crossed!

So after six weeks of this combined treatment, I'll take four weeks off to allow my immune system to recover from the abuse. Then I'll be taking the chemo again, but only five days a month, for the rest of the year. There will also be an MRI after ten weeks of treatment/recovery, to see if the tumor has returned. If it has, it could be that treatment would change too. The Optune -- that electromagnetic device that attempts to interfere with cancer cell mitosis -- is apparently only used if the tumor returns. But one thing at a time. I just hope I survive the first phase without some of the worst side effects that are possible. I'll spare you the details on those, but I hope to keep you updated on how I'm handling the treatment as I go through it.

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randy_byers
Jan. 9th, 2016 10:28 pm (UTC)
Too true, although I was told that the radiation in particular might make what's left a little patchier. I was interested to hear that it wouldn't affect my facial or body hair, which seems a little strange to me. They did say that it affects fast-growing cells, like cancer or hair. Maybe facial and body hair isn't quite as fast-growing as head hair.

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