You can read the first and second updates if you need to catch up on the dilemmas I faced with regard to treating/killing/freezing/nuking/blasting the pesky met. The cliff’s notes version is that there is one metastasis that just won’t die and it’s located in my right pubic synthesis; the options I was considering were cryoablation and radiation; additionally, consulting with the Bone Mets Clinic at Duke in North Carolina as well as local doctors at my cancer center in Miami. What made making the decision even harder is that I received differing advice from different doctors and had to evaluate the reliability of each recommendation on my own and with my medical oncologist, which wasn’t an easy task.
After talking and talking and talking some more to various doctors, my family, other advocates, etc., reading lots and lots and lots of literature/studies/articles, and going back and forth and back and forth and back and forth again …. I completed three (3) rounds of Stereotactic Body Radiotherapy (SBRT) to the pesky met at the Miami Cancer Institute (MCI). You might recall the shrink wrapping pictures from the planning sessions, which was done to ensure that I stayed very very very very still during the procedure. The pressure I felt was equivalent to 55 pounds per square inch (psi) and I had to endure that pressure for about 15-20 minutes for each session while the physicist and the doctor checked to make sure I was properly in place.
My new radiation oncologist had a front row seat to my dithering and attempting to compare apples to apples and was patient enough to read and respond to the articles I sent him as well as talking repeatedly to my medical oncologist as I pressed her to give me her recommendations and direction. Additionally, he sat down with me and reviewed the entire plan, showing me how each physical structure near the pesky met could be affected and how he adjusted each of the metrics to be even safer due to the potential issues that could be caused by ATM, the germline mutation I have. He was flexible enough to bend on the original boundary that we had to have a biopsy that showed cancer before starting radiation due to the totality of the circumstances since I wasn’t excited about undergoing another biopsy when the first wasn’t successful.
The value of SBRT was that I received the equivalent of five (5) weeks of radiation to the pesky met in just three sessions and the treatment is precise enough to spare the sensitive structures around the met from damage. The adjustments my radiation oncologist made meant, for example, that even my skin only received about a third of the radiation it could absorb without being damaged.
Radiation is a weird treatment to undergo because while the lights and movements indicate that the machine is on and doing something, you don’t feel anything and, for me, there are no immediate side effects or physical ramifications. The HUGE thickness of the doors and walls around the machine are a little intimidating because everyone else is clearly shielded from what you are directly exposed to and yet you just lie there and wait and wait to feel something. The bed I was on could move in four (4) dimensions, which made it even easier for my team to ensure that I was exactly properly placed for the beams to do the best job.
At the end of the three (3) sessions, I received a medal and a certificate and I was invited to ring a large bell. I’ve written before about the bell and how ringing the bell affects those of us who will never be truly done with treatment but this was the first time I was invited to ring it. I’ve had chemo and radiation previously at a different cancer center and I suppose it just wasn’t as big of an issue or option there. I declined to ring the bell as I’m still very ambivalent about it overall. I am happy to be done with radiation, but it just didn’t feel right to me.
While my radiation oncologist usually completes a CT scan at the 8 week mark, since I’m already scheduled for a PET/CT in March, we agreed to see what that shows and then decide if I need another CT after that. If radiation was successful in nuking the pesky met, I may actually finally achieve No Evidence of Active Disease (NEAD). Not counting on anything right now, but mildly hopeful that perhaps the next PET will be time to celebrate.
Here’s some of the pictures I took on my final day of Radiation:
And so, another part of my treatment ends and I continue on with the targeted therapies I’m on. I’d adjusted my cycles of Kisquali due to getting the 2nd COVID vaccine shot the same week as radiation, so I’m now back on the regularly cycle of 3 weeks of Kisquali and one week off. Keeping fingers and toes, and whatever else I can cross, crossed for good news next month!