 |
| |
Part 8:
IMRT Underway
On April 14th my first real meeting took place with the wondrous
machine which would cure my cancer. The machine is called a CLINAC
2100C - Therapy Accelerator. I am positioned on the adjustable table
under the guiding parameters of the red lasers shining from the
ceiling and walls. The lasers are perfectly aligned with the tattoo
marks on my body. The custom body mold is then fastened down to hold
my body in a precise position.
The three radiation therapists leave the room and a massive steel
door is closed leaving me in contact with them via a T.V camera and
audio if I require any assistance. The computer then positions and
operates the CLINAC 2100C to duplicate the specific radiation angles
prescribed by the program along with the appropriate radiation
dosage. The machine whirs to one position and fires a continuous
burst of radiation for about forty five seconds the first time. This
operation is repeated four more times, each at a different programmed
angle and each for approximately 30 seconds. The entire operation is
painless and takes about 15 minutes. The most difficult requirement
is to lie absolutely still during this entire period.
I am told that I receive 1.8 Gray (180 RAD) of radiation per
session. The sessions will be repeated 5 days a week for 9 weeks. By
April 18, 1997 I have completed five sessions and have no ill effects
whatsoever from the radiation. The only noticeable effects of the
treatment so far are the periodic hot flashes which occur after I
retire at night. This is but a minor inconvenience and will cease
when I stop taking the Lupron and the Casodex in another eight weeks.
The most difficult part of this entire operation is
that related to travel to Memorial Sloan Kettering every day. The trip
involves a two hour train ride from Hyde Park NY which is located
about 100 miles away, a half hour subway ride, and a half mile walk.
Then the procedure is repeated in reverse. Weather permitting, I will
walk the two miles (about 30 city blocks) back to Grand Central Station,
in lieu of the subway, after each procedure, for the value of the
exercise The entire operation, including treatment, takes about 7
hours.
I found that I was exhausted from the trip after the first two
days. However, by the end of the week my body had become accustomed
to the ordeal I felt fine when I arrived home and felt no degree of
tiredness whatsoever.
April 18, 1997
My radiation oncologist Dr. Zelefsky called me into his office
after the procedure for that day was completed. He had some wonderful
news for me! An evaluation of the films taken during the Simulation
and the dry run indicated that the first three months of the hormone
ablation phase had done a superb job. The ablation had reduced the
size of my prostate to about half size, as was expected.
In addition to the size reduction, the x-rays showed that the
spacing between the smaller prostate and the nearby organs had "an
excellent wide gap" to quote my doctor. The significance of this is
that the laserlike accuracy of the radiation beam can be focused on
the prostate without damaging any of the surrounding organs.
Dr. Zelefsky indicated to me that I should have no adverse side
effects from the radiation for at least 5 weeks and then these
reactions should be minimal or perhaps nonexistent. At the end of the
9 week treatment any side effects which do present themselves should
rapidly dissipate. This excellent prognosis is due to the wide safety
margins produced by the androgen ablation phase and the precision of
the machine to direct radiation with laserlike accuracy.
Memorial Sloan Kettering has been using the 3-D Conformal Radiation Therapy
for about six and a half years. During this period of time the
procedure is being constantly improved based on results gleaned from
patient history. The advantage of employing the androgen ablation
phase concurrent with the radiation phase is one example of this.
At first levels of radiation amounting to 65 Gray were used on
patients. Higher levels of radiation could cause damage unless the
mechanics of the treatment was of superb precision. Over the years
the precision of the equipment and the computer program improved as
more and more patients generated additional operational data.
Gradually, the amount of radiation was increased through 75.6 Gray.
As mentioned earlier, current data indicates excellent results as the
level of the radiation dose approaches 81 grey (8100 RAD).
Dr. Zelefsky indicated to me today that the latest compilation of
data on patients who had received 81 Gray (Gy) of radiation indicate
"Phenomenal success" in curing their cancer completely. My dosage
will be 81 gray. Considering the spacing the ablation phase has
provided it now appears that I can expect not only a complete cure in
8 more weeks and virtually no adverse side effects.
April 26, 1997
The end of the second week of treatment. Still no adverse side
effects from the treatment. The daily journey to N.Y. is a bit
wearing by the end of the week but tolerable.
This week the Radiation Therapist took another series of five
"films" one along each of the radiation planes. This was similar to
the "dry run" except that the particle accelerator itself was used to
expose the films with short bursts of sub-atomic particles. This
procedure will be repeated once each week to insure that nothing has
changed regarding the orientation of the internal organs or the body
orientation during treatment.
May 2, 1997
The end of the third week. Still no adverse reactions to the
radiation. The usual "films" were taken again this week to reconfirm
perfect alignment and a blood test was taken to insure no changes in
blood chemistry. None were found.
During a discussion with one of the doctors I was advised that
some men show some negative reactions to the radiation after only two
treatments. Others can take the entire 42 - 45 sessions with no
negative reactions at all. So the response of one person does not
guarantee the same response in another patient.
May 9, 1997 - The Fourth Week
Twenty treatments have now been administered and I still have no
adverse negative reactions. The daily trip to New Yrok is now
inconsequential and has no tiring effect on me at all.
This week brought excellent additional news from my doctor. He had
previously reported "phenomenal" results, based on accumulating data,
when the entire treatment includes 8,100 RADS of radiation vs. the
7,560 used previously. This week I asked him to quantify his
statement with a number. His words were "Let me put it this way -
With the 8,100 RADS and NO androgen ablation the rate of positive
biopsy has been reduced 95%.
With the Androgen Ablation process included the cure rate will be
closer to 100%". That is certainly good news! This also points up the
rapidly developing advance of radiation as a treatment for prostate
cancer and the value of having that treatment administered by an
institution with a very massive experience in the 3-D technology -
11,000 + cases and 6 years in the case of this cancer treatment
facility.
Last November, when I first met Dr. Zelefsky, he
indicated that the cure rate would be 60% for the radiation alone and
70% if the androgen ablation is included in the treatment - about
the same cure rate as surgery (Radical Prostatectomy) or seeding
(Brachytherapy).
Besides increasing the cure rate, the androgen ablation also
shrinks the prostate and increases the spacing between the prostate
and nearby organs so that collateral damage is eliminated or greatly
reduced. Now, six months later, the accumulated test data, from prior
years, has indicated that an increase in radiation to 8,100 is
feasible and that this will effect a near perfect cure. A cure rate
of over 95 % is higher than any other form of treatment including all
present surgical and nonsurgical procedures. Again - a vast benefit
as the result of going with a leader in the field of cancer research
which has a massive history of patient treatment and response in its
archives.
May 16, 1997
The end of the fifth week. I have now crossed over the halfway
point in my treatment.
At this point in the treatment I have come to realize that there
is a side effect of the treatment which has become more noticeable.
Specifically, I note the increase need to urinate. At present it is
necessary to go to the bathroom about 4 times after I retire. There
is also some increase in urination during the day (about 6 times). My
review of the literature points out that this is a normal response to
the radiation and should not become more acute.
Fortunately, control of my bladder is perfectly normal so there
are no serious consequences except perhaps the interruption of a good
nights sleep. My references point out that the condition should
disappear about 2-4 weeks after the treatment stops.
May 23, 1997 - The Sixth Week
During my weekly meeting with Dr. Zelefsky, I presented the subject of
the only two minor side effects I have noted to date. (1) The need to
urinate four times after retiring vs. once before the treatment
started and (2) rectal irritation. The latter is a mildly irritating
sensation, at the lower rectum, during a bowel movement.
Dr. Zelefsky indicated that both symptoms are common among 3-D
radiation patients and that both would vanish after the completion of
the treatment. During the developmental phase of the treatment a
multidisciplinary study was conducted to determine the cause of
rectal irritation. It was found that this symptom was simply a case
of low order hemorrhoidal inflammation. Having been treated for a
major outbreak of this malady many years ago I knew the symptoms were
similar but to a much lesser degree.
Fortunately both of these temporary side effects of the radiation
can be easily alleviated.The urinary problem is resolved by the
administration of 2 mg of Cardura (Doxazosin). This is an alpha
blocker used to treat high blood pressure but it is also effective in
relieving the temporary urinary problem. The rectal irritation can be
reduced by the use of Hydrocortisone suppositories administered prior
to bed time and by taking sitz baths a few times a day or at least
before retiring.
I tested the efficiency of the Cardura to resolve the urinary
problem experienced after I retire. The results were astounding! On
the first night a single 2 mg tablet of Cardura immediately reduced
the need to urinate from four times to one - which was the normal
amount before my treatment began. The rectal irritation has also
virtually disappeared as a result of use of the Hydrocortisone and
the use of Metamucil.
5/30/97 - The Seventh Week
The temporary post bedtime urinary problem has largely disappeared
with continued use of Cardura and sensible liquid intake which
includes little or no liquid intake between my final meal and the
time that I retire. The "rectal irritation" has also largely
vanished. I have discontinued the sitz baths and rely on the
Hydrocortisone and Metamucil.
6/6/97 - The Eighth Week
I have begun to notice some side effects from the Cardura. These
include: watering of the eyes, itching on the back of the neck, and
eventually a small red rash on my face. Checking the medical
literature seems to confirm this as a possible Cardura side effect. I
have discontinued taking the Cardura with no adverse effect.
6/13/97 - The Ninth Week
I have noted an inclination toward greater fatigue related to the
travel to treatment in New York from a suburb of , N.Y. This entire
daily trip, including treatment, takes 7 hours to complete. I have
made it a practice to walk the 30 city blocks from the hospital to
Grand Central Terminal at least three times per week. On other days I
make use of the subway. By Friday I find that I am beginning to
notice the fatigue.
7/13/97 - One month after treatment
Virtually all of the adverse symptoms developed during the later
stages of treatment have disappeared. Within two weeks after
treatment I felt superb once I had rested up from the regimen of
daily travel for treatment. My sexual activity has returned to normal
without impairment. In fact, the wear and tear from the travel was a
greater factor than that from the treatment itself.
If I had been able to obtain the SAME EXACT treatment in a local
facility, I would have considered the side effects of the treatment
virtually inconsequential.
8/5/97 - Seven weeks after treatment
I returned to the treatment center for a post-treatment checkup. A
digital rectal examination by my radiation oncologist indicated that
my prostate is now perfectly normal. Any abnormalities observed prior
to treatment have now vanished.
The blood test taken today indicates that my PSA level is now
0.17!!!! A successful treatment is indicated by a PSA level of
less than 1.0.
|
|
| This information is provided for educational purposes only and does not replace or amend professional medical advice. Unless otherwise stated and credited, the content of Phoenix5 (P5) is by and the opinion of and copyright © 2000 Robert Vaughn Young. All Rights Reserved. P5 is at <http://www.phoenix5.org>. P5's policy regarding privacy and right to reprint are at <www.phoenix5.org/infopolicy>.
|
|
