Next Stop, Radiation?

Posted 16 March 2016

Earlier this week, I saw my primary oncologist, Dr. Peter Brett, and he recommended radiation as the next step.

It feels a bit like an unexpected side trip, since radiation has been mentioned only in passing.

I suspect this possibility was in Dr. Brett’s mind from the start, but that laying out scenarios for what I might do if the chemo doesn’t keep working isn’t something he would have brought up before now.

At this point, there are no promising chemotherapy treatments, so radiation is the remaining method (outside of possible clinical trials) for shrinking the tumor and stopping it from growing back for a little while.

In return for two weeks of short daily visits and a few more weeks of side effects, the radiation treatment is expected to buy me a few more months.

Unlike chemotherapy, radiation is pretty reliable at killing cancer cells in a specific location, because it is physically targeted rather than systemic. Radiation doesn’t affect the metastases, unlike chemo, so chemo is the place to start when you have a metastatic cancer, as I did.

Now, my cancer is concentrated between the duodenum and the pancreas, with only some minor metastases, so radiation is the tool of choice. Radiation is a sort of universal poison, killing whatever cells get a high enough dosage. Cancer cells, fortunately, are especially sensitive to radiation.

Of course, radiation therapy does some collateral damage to nearby tissues, and that’s where many of the side effects come from. If you get one of the rare side effects (on the “< 1% of patients” list), it can get nasty, but at least here the odds are in my favor.

Starting Soon, Unless …

Today I met with the radiation oncologist, and I am on a path to do 10 days of radiation treatments, starting at the end of the month, unless something causes me to call it off.

After having been through chemo, the radiation treatments sound quick and easy, and the side effects moderate (though I know it won’t be that easy).

In the next week, I’ll be seeing another oncologist for a second (third, fourth … ) opinion, as well as the clinical trials folks at UCSF.

One issue is that clinical trials require that you not have had radiation for at least 30 days, so doing the radiation now could delay my ability to join a trial. We’ll see if any of the UCSF trials looks promising, but my expectations are low.

I can’t say I’m looking forward to another treatment regimen, but I am starting to have pain again from the tumor, or something it is pushing on, and the prospect of having it shrunk is hard to resist.

I find that my emotional state is pretty good as long as I’m feeling healthy enough to do stuff. When the pain gets too great, or my energy level too low, my emotions start spiraling down. Thankfully, the dark periods haven’t lasted long.

I am so ready to be done with the world of medical treatments, but at the same time I’m not ready to pass up its potential benefits.

I expect that the radiation will be hard on my energy and comfort level for a few weeks, but if all goes well I should then get some months of feeling better. Getting a period of time that is relatively pain-free and during which my energy level is good would be a big gift.