I saw the radiologist for the first time Wednesday and have been digesting the information ever since. I was put at ease immediately about whether my cough will be a problem (apparently not) and learned a lot about how things will proceed from here, although I’m not yet sure of the time frame.
The doctor will employ IMRT, or intensity-modulated radiation therapy. As explained on the website of the Radiological Society of North America:
IMRT allows for the radiation dose to conform more precisely to the three-dimensional (3-D) shape of the tumor by modulating—or controlling—the intensity of the radiation beam in multiple small volumes. IMRT also allows higher radiation doses to be focused to regions within the tumor while minimizing the dose to surrounding normal critical structures. Treatment is carefully planned by using 3-D computed tomography (CT) or magnetic resonance (MRI) images of the patient in conjunction with computerized dose calculations to determine the dose intensity pattern that will best conform to the tumor shape.
The radiation will be directed over my entire left breast, with “boosts” of extra radiation to the site of the tumor and the nodes directly behind the breastbone that showed up on the original scans. She explained that sometimes radiation will include the area above the collarbone and in the arm on that side, both locations of more lymph nodes. I was relieved when she said she would not include the arm because that can result in lymphedema, something I’ve managed to avoid so far because the sentinel nodes on that side were clean. (I hope she also meant she would not go above the collarbone and/or irradiate the shoulder, but I’m not sure.) I’m relieved because she’d noted earlier that radiation can cause some weakening of the bone, and I’ll probably have enough bone problems in later years without irradiating the good ones I have.
She didn’t mention, but her handouts did, that radiation to the chest causes some weakening of the ribs. Hadn’t counted on that and am not thrilled with the idea. At 72, I’ve yet to break a bone, and I’m not eager to start now.
As for side effects, she spoke almost entirely about reddened, irritated skin, usually relieved with assorted topical creams and emollients. Also, longterm, the irradiated breast could draw up and become a bit smaller. I doubted it was all quite as simple as she made it sound, and it isn’t. Her handouts included an entire page detailing the types of fatigue I might experience. Goodie. More fatigue. Getting really tired of being tired.
I return to radiology on Wednesday for what’s called CT simulation. They’ll do a CT scan to see what they’re dealing with, and then figure out exactly how to position me on the table and where and how to aim their beams. They’ll place a couple of marks or tattoos on my chest to ensure the same aim for each treatment.
Their handout says normally treatment will begin about a week after the simulation. I’ve read elsewhere it can be up to two weeks. I sure wouldn’t mind having that extra week to recuperate. Especially since she said treatment will run 5 days a week for 6.5 weeks. She thinks a lower dose for a longer period of time will be more effective. I suppose I should be happy that at least I’ll be done before the holidays and before winter really sets in.
Meantime, I return to the oncologist on Tuesday for my first Herceptin-only infusion (which will be repeated every three weeks for a year). I’ve been told no Decadron beforehand, no Zofran (for nausea) in the days following, and no Neulasta will be necessary. All of which are changes from the previous regimen. But you know me, anxious as hell anyway. Every side effect I’ve experienced to date is listed as possible for Herceptin-only treatment. Some people in online forums complain of a lot of side effects; some say it’s a piece of cake compared to the full TC-H regimen I just finished. Which means basically I don’t know what to expect. But personally, I’d prefer a piece of cake.