The Medical Oncologist (chemotherapy expert) in Lancaster gave me some difficult news. The radiation is going to do some things I had not anticipated fully, and the chemotherapy is going to be much worse than I understood, from what I had originally been told. He advised me to get the chemotherapy done in Los Angeles, where the radiation can be done immediately afterward, so I got an appointment to see the Medical Oncologist down there.
Apparently, the chemotherapy they will be using is more aggressive than usually used on this particular type and location of cancer, in the hope that it will combine with the radiation to make an absolutely complete cure, with no chance of recurrence. The plan is to weaken the cancer, and strengthen the healthy cells nearby, make the cancer more susceptible to the radiation while protecting the healthy cells, and to target the very short-wavelength (read narrow and accurate) X-rays very precisely, to kill the cancer but leave as much as possible of the healthy tissue alone. The radiation will scramble the DNA of the cancer cells, so they cannot reproduce or continue to regenerate. The linear accelerator is the newest and best IMRT (Intensity-Modulated Radiation Therapy) and uses Smart Arc programmed control, to adjust the beam more accurately, and offer the best chance to cure, with the least collateral damage. The radiation damage on my neck, and the stripe through my beard where the hair doesn’t grow during the treatments are unavoidable. Of course, the chemo may make my hair fall out anyway, so a stripe through my beard will not be much of an issue.
A hypnotic video on how Linac works:
[Some of the stuff, especially after about 7:00 is specific to one manufacturer and model (Elekta Synergy) but most of it is exactly what Kaiser’s Linacs are like too.]
A deeper delve into radiation therapy equipment, which fascinated this lifelong science nerd and electronics/computer instructor:
Here’s a slide show created for the U. S. DOE Department Of Energy) to accompany a talk given on Linacs. The actual talk is not there, and it points heavily toward charged-particle therapy (which is not what I am getting) but some of the history and forecasting are enlightening:
I am having a dizzying series of appointments to see various different doctors, all of whom will be co-operating to kill the cancer without killing me… too much… The plan is to kill me mostly, but the cancer completely, and then bring me back. Think Princess Bride, when Wesley was “mostly dead.” All of these appointments are now “Down Below,” in the Los Angeles metroplex. That’s where they will be pumping me full of poison (Cisplatin) and shooting death rays through my neck and jaw.
I went to UCLA dental again, to get the fluoride trays, and later that morning, to see the Medical Oncologist at the main facility in Los Angeles, to learn about diet, and a lot of other stuff to do with the chemotherapy. A couple of days later (Thursday, 9/3) I will go to have a rigid plastic web mask made to hold my head absolutely still during the irradiation, and have a PET scan done to get the most precise possible picture of where they need to irradiate, and where they can leave healthy tissue alone. It involves giving me an IV of radioactive sugar, which the cancer will gobble up greedily (much faster than healthy cells) and in that way mark the cancer very clearly for them to target the radiation treatments precisely.
I am definitely going to hate having my head clamped to the table, and may need Ativan or Valium to keep from doing something both embarrassing and dangerous. I have never dealt well with being immobilized, and in the last few years it has been worse. The day after the PET scan (Friday, 9/4) I will see the Radiation Oncologist (captain of my team) to plan the actual treatments. It will almost surely be 7 weeks of radiation, Monday through Friday, with the Cisplatin being infused intravenously three times, spaced throughout the treatment period.