Beams not beads

The first step in my revised treatment plan -- the "beams not beads" plan -- is scheduled for tomorrow, Monday, June 4. It’s called a “simulation” session, but it’s not really just a simulation of the radiation beams to come. Instead, during this session they will create a mold of my torso, or rather of my back, and then I will lie in this mold for all my future radiation appointments. The essential thing, it appears, is to make sure that the radiation beam is as accurately aimed as possible, and so they need to make sure that I’m actually lying on the table in exactly the same position each time. They will also tattoo my torso, again to mark the correct targets, and these tattoos evidently are the real thing – they’ll never go away. (Perhaps after the treatment is complete, I can get someone to tattoo “Momma” in a way that incorporates the medical markings.)

And then we’ll start, I think probably in the week of June 11. I’ll either have 15 treatments or 25, depending on how big a dose they want to administer each time. As I understand the schedule, those 15 or 25 treatments will take place every week day until the full dose has been administered. I’ll go into Sloan Kettering each day, get a 20-minute dose of radiation, and go home – or, for that matter, go out to dinner. They expect I’ll have few side-effects, though perhaps a few weeks in I’ll have enough fatigue that I won’t be dining out.

It’s interesting that I don’t get treatments on Saturday or Sunday – as far as I know – since it seems unlikely that my tumors or my liver are aware of the difference between weekdays and weekends. But there may be some medical benefit to pauses every few days, and I suppose weekends are the natural time for pausing.

The radiation oncologist, with whom we met on Wednesday, May 30, was very clear and quite encouraging. What I am going to have is called SBRT, or stereotactic body radiation therapy: very precisely aimed and quite high-dose radiation treatment. It utilizes photon radiation, which evidently for me will consist of X-rays. An alternative might have been proton radiation, and we asked about this, but the radiation oncologist told us that there was no evidence that the greater precision of proton radiation actually makes a difference in most patients, and he didn't think it would add anything for me. 

The radiation oncologist believes that he can reach all of my active tumors with the radiation. (That’s better than what we were anticipating with the radiation beads, because apparently my blood system didn’t offer good access for the beads to reach at least one tumor area.) He also plans to continue the treatment until it reaches ablation dosage; “ablation” in this context appears to be a synonym for destruction, and this is the first time that we’ve been told that they could achieve that. He said the chance of tumor death was 80 - 90 percent! If they can actually destroy all my active tumors, that would be great – even if, as is conceivable, at some future time these or other tumors may appear again.

All this makes us wonder a bit about why I was never put into radiation treatment before. Some part of the answer may be that I started in chemotherapy, which is the standard treatment for people whose tumors can’t be surgically removed, and basically Sloan Kettering’s strategy was to keep me in chemotherapy as long as it produced results – and then to try something else. It makes sense to get the most out of any one treatment approach before trying another, as long as it doesn’t for one reason or another get to be too late to switch by the time switching is needed, and fortunately I’m able to make this switch.

But another part of the answer may have to do with the particular course my cancer has taken. Apparently the largest tumor masses showed up on my recent PET scan as inactive. Our oncologist, I think, suspected this was the case even before the PET scan, but that scan certainly added evidence to support this assessment. Inactive might mean “dead,” which would be great, or it might mean just “inert,” which would be good as long as we can keep them this way. It's possible these tumor areas were originally too large to treat with radiation, but they are also close to various healthy parts of my body that could be harmed by radiation inadvertently hitting them; now, happily, it seems there's little or no need to try to treat these areas. So radiation now makes sense in a way it didn’t before, because the parts of my cancer that it might be risky to target with radiation aren’t active, and the parts that are active can be attacked with radiation without significant risk to anything else.

So the next step is the “simulation” session, and then, soon after, the real thing begins.

******

And in other news – at New York Law School’s graduation ceremony yesterday, June 1, I received the school’s President’s Medal, for what the award citation called my “innumerable, deep, and lasting contributions to the Law School” and for my “lifelong work to advance social justice and uphold the constitutional principles our community holds dear.” I also got 5 minutes – apparently I actually took 7 – to speak to the graduates. I felt moved and very honored and grateful. And here’s a picture Teresa took of me during my 7 minutes at the podium: 

(The picture doesn't show the event's principal speaker, US Supreme Court Justice Stephen Breyer, who got 15 minutes and used them really well!)