Nuke the whale

On Monday June 3 I drove to the Huntsman Cancer Institute in Salt Lake City for a “pseudo CT” in preparation for my radiotherapy. A pseudo CT consisted of my laying bare chested face up on the table that slides into a CT machine and getting marked for radiotherapy. The first part of marking consisted of immobilizing me. A tech shaped a pillow to cradle my head. The pillow was filled what felt like small silica beads. When the pillow was perfectly shaped, the tech injected a quick-setting gel into the pillow which caused it to lock into shape.

After the pillow had hardened, two techs brought a warm mesh fabric and pressed it all over my face, shaping it around my eye sockets, nose, chin, cheeks, ears, and jaw. I had to hold very still while the mask dried. I could breathe through the mesh, and with some effort could blink my eyes, but could not focus on anything. Nor could I lick my lips, which I found was the most difficult part of wearing the mask. The hardened mask was attached to the pillow. My head and neck were totally immobilized.

Good evening Clarice

Once I was locked in place, the techs drew four small circles on my chest: one on each shoulder, one at the base of my neck, and one above the sternum. They also made four marks on the mask. They then aligned lasers within each of those circles. Where each laser instersected, the tech marked a single point. A brief CT scan allowed the techs to map my supraclavicular metastatic tumor in relation to those points. Once the location marks were confirmed, a tech returned with a tattoo pen. She inked four points on my skin, which would serve as a permanent reference point for each radiation treatment. Each point was smaller than a mole, and barely visible from a few feet away.

With that, the preparatory portion of my radiation therapy was done. I was told that on the following week I would have three sessions, receiving 10 Gy of radiotherapy in each session. I was told that I should feel no of very little adverse effects. Driving myself to and from each session was perfectly fine. I scheduled each of the sessions so that I would arrive after the morning rush hour (although Salt Lake’s traffic is nothing compared to the DC area) and get out before the afternoon rush.

My first session was on June 10. I was told that the techs would lock me into position on the table, take a quick CT scan, and review the radiation plan with the radiologist. With the mask on, my other senses were more attuned and I could feel the CT scan as it vibrated through my neck and chest. After the CT scan was over, I relaxed my grip on the handles and moved my hand. I tech immediately came into the room and told me that, because I had moved, they would have to do another CT scan. I mumbled an apology through my mask and was about to say that no one told me not to move, but thought better of it as I realized that was the whole point of immobilizing me.

Don't move or we'll nuke you

I assume that Dr. Lloyd approved the radiation plan, because after a few minutes the machine started whirring and rotating. The SBRT (stereotactic body radiation therapy) machine has the ability to shape and target the gamma beam to focus only on my tumor and not any other part of my body. The machine slowly circled my body as it irradiated my tumor. I could feel the warmth of the machine as it circled, but of course could not actually see the thing through my mask. I hope this actually works I thought, preparing to spend a half hour or so on the table. But after less than three minutes, I was done. That wasn’t so bad, I thought. It’s not much different that a dry CT scan. Less than 45 minutes after arriving, I was on my way.

I have two other sessions this week. My next CT scan with contrast is scheduled for June 27. With luck, my persistent tumor in my upper chest should be gone. Of course, I don’t expect to be cured by this radiation – all we’re trying to do is nuke the biggest and most durable tumor. I understand that the nature of my metastatic cancer means that I likely have microscopic deposits of cancer throughout my lymphatic system. All we’re doing is whacking the most visible area of cancer. Eventually, my mets will pop up somewhere else, and the game of cancer whack-a-mole will continue. Meanwhile, I’ll continue with my immunotherapy until someone has a better idea.