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.