Saturday, November 14, 2009

Follow up radiation

So ever since diagnosis I've been working with doctors who felt it best to treat with chemotherapy and avoid radiation. The conventional wisdom, they said, was that the toxic effects of chemo, especially long term, were less of a risk than radiaion. While I was undergoing chemo I was counting on that being it for treatment. I felt, at times, priviledged that my doctor was so enlightened as to keep me on a (relatively) low impact treatment path.

Now that the chemo is over things are not so cut and dry. The standard treatment for my disease process is to do some consolidative radiation therapy for "clean up" after the chemo is finished. With bulky Hodgkins there is usually a residual mass where the large tumor was. Most likely this is scar tissue, which is deposited as the tumor grows. My oncologist is leaning towards avoiding radation, but she made me an appointment with the radiation oncologist at WHC.

I met with the radiation oncologist last week. It was an informative meeting and worth having. He made some compelling arguments about follow up radiation. 1. It's the standard of care for my disease process - why not give yourself the best chance based on the current available evidence, since the therapies for relapse are brutal. 2. Current targeted field methods don't have the same impact than the older wide field "mantle" therapies that most of the follow up studies are based upon. On the other hand, I know I had excellent response from early on to my chemo regimen. I seem to have so far avoided the potential lung toxicity from the drugs - and I don't want to go through another treatment that brings that risk back from another angle. And it's just plain good to be "done."

But I've found that you're never done with cancer. Even when you are. Passing on radiation because my primary oncologist has given me permission and I want to be "done" has a reckless feel to it. Even though at this point I feel well and I MOSTLY believe that I have been cured. When I first spoke to lymphoma specialists at NIH and they described the likely proscribed treatment, emphasizing that the best outcomes correlated to getting the treatments on schedule for the durration I thought "Heck yeah! Bring it on. If that's the plan, I'll show up on schedule when and where." And I did that. I watched my doctor give the infusion nurses special instructions to treatment even when my white blood counts were below the "normal" threshold. The standing orders for me were "If you can measure something, treat him." I dutifully marched in even when the anticipatory nausea set in later on, and I fought it down by force of will on the very last treatment.

Right now I don't know what I'll decide. I'm going to go into the radiation oncology center so they can map my targeted treatment area. And I need to have another consult with my primary oncologist to further discuss pros and cons. Do I roll the dice that my body responded well enough to the chemo to get me to final remission, or do I roll the dice that it will continue to hold up to another course of potentially damaging treatment?

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