Sunday, September 13, 2009

Radiation summary

For lymphomas, two radiation schedules are common. One is 180 centiGray per day to a total dose of 32 Gray. The other is 150 cGy per day to a total dose of 36 Gy. My radiation oncologist chose to give me the 150/day treatment. He believes the lower daily dose has a lower risk of long-term side effects, even though it requires a higher total dose to be effective. There's not enough good data to make a definitive statement on the issue, but his position sounds reasonable.

My area hospital has a proton radiation machine, so that was what I got. It delivered one dose to my front and one to my back to a about 3.5"-wide strip that started just above my collarbone and extended down my chest about 6". Ideally, they would have treated the entire original area of my bulky tumor. However, the radiation oncologist explained that because radiation to large areas of the lungs is a bad idea, they restricted the width to the mediastinum.

They radiation oncologist and his staff explained to me the most common side effects of radiation to this area: painful swallowing (the esophagus is in the radiation field), coughing (some lung is in the field), and skin damage. I think three different people went over each of these side effects. They gave me a prescription for RadiaGel and told me to apply it three times a day, and to let them know right away if it became painful to swallow because they have drugs that can make that less bad. I think someone might have mentioned being tired was also a possible side effect.

I was more mentally prepared for the physical side effects, I think. They never came: applying the gel twice a day kept my skin from doing anything worse than turning very slightly pink; my esophagus sometimes felt warm and sometimes I felt like it was a very good idea to chew thoroughly before swallowing, but I never had any pain; and I never developed a cough. Two to three weeks into my five-week treatment, however, the fatigue came on.

In part, this was feeling tired and completely unmotivated to do anything productive. I also had to cut back the intensity of my exercise videos: aerobic workouts I had done without trouble two weeks before left me panting with a sky-high heartrate. In addition, I developed an aversion to doing anything that required thinking hard: playing piano, knitting, writing... I had been so happy to enjoy these again after chemotherapy, and they were gone once more.

I'm lucky to have not have any major physical symptoms from the radiation. The surprise of acquiring such intense fatigue made it difficult to appreciate at the time, though. It's easier now (a week and a half out of radiation): I'm not feeling completely normal, but I'm very close. Moving in the right direction.


Anonymous said...

hi,lyrl,this is rajnish from india i had been writting to your earlier also but recived no response from your side,i and my family wish you speedy recovry,pl get the treatment properly as you never know what i told you earlier that i went into cr on in may 2009 and was very happy to see the diease go but to gods fate in the three monthly follow up in the pet the disease again came back with the same aggresiveness and i am again undergoing chemo salvage theraphy followed by stem transplant i am very scarred as i have family to support and even not having enough funds for treatment pl do read this and give some advice and tips as your earlier tips were very useful and helpful,waiting for aa response,bye rajnish ,india

lyrl said...

I am so sorry to hear of your relapse rajnish. I do not have any personal experience with stem cell transplant, but if you have any specific questions I would answer them as best I can.

I wish you an uneventful but successful transplant and a speedy recovery.

Anonymous said...

hi,thanks for your response,i have taken one cycle of r dhap chemo,the exprrpeience is awful,no taste buds,cant eat anything,feel dizzy all the time and want to sleep,is there any other way to finish the treatment without transplant,i am afraid as i have family dependant on me,pl try to search if you get times i think why me for all this agony,what about your treatmwnt is it over and what result pl'inform

lyrl said...

Stem cell transplant is the standard treatment for relapsed lymphoma. It is the only option that is potentially curative.

Yes, my treatment is over. I see my oncologist in February and will have my next scan in June 2010 (one year after my last scan that was done in June 2009).

Anonymous said...

hi,lyrl ,how are you feeling ,i took 4 cycles of r dhap tharaphy and after 2 cycles size reduced to 8 x 2.7 cms with suv value of 4.3 from 14 cms suv value 18.3 and then again i took two cycles more and got a pet done but the result is the same hat was after 2 cycles i.e more than 50% response ,now my local oncologist wants to try new chemo protocol on me whereas some oncologist say that since the disease is localised at one place go for radiation,ou have studied too much,pl advise what is a better option ,i have already taken 10 cycles of chemo,pl tell ,rajnish india

lyrl said...

Long-term, radiation has more bad effects on health. Short-term, radiation has a slightly higher cure rate. Between new chemo combinations and radiation, there is no "better" option - they are just different.

I am very sorry to hear your disease is resistant to the R-DHAP. Best wishes in your decision on what to do next.

Anonymous said...

hi,lyrl,i was not able to acess net as i was away from my place for radiation,i received 40 grays radiation spread over 5 weeks,now my pet is sheduled for 23 rd april,hoping for some good news,lets what god has for me.
How is your health any problems being faced ,we here always pray for you,your help has given me great inspiration,pl be in touch,bye.