So it is decided, I will have consolidative radiation treatment now that the chemotherapy is over, even though my scans were "negative" for cancer. I didn't think this would be the case earlier on. The medical oncologist I worked with at NIH and my current hematologist all warned against radiation therapy for someone my age. They cited the long term side effects of radiation as being significantly more dangerous than those of my chemotherapy regimen. They had me convinced that once I was done with the chemo that would be it.
As I neared the end of chemo I took another look at the role of radiation. I brought it up with my primary dr. near the end and she thought I should speak to a radiation oncologist at the Cancer Institute. I had that consult and he made some compelling arguments in favor of it. First, it IS the standard treatment protocol for the stage/presentation of my disease. Second, the impact of current targeted regimens is much different than the long term historical data which is mainly based on higher doses, and longer durations where radiation was the primary therapy for Hodgkins. Third, the impact of second line or salvage therapy would far outstrip that of targeted radiation should I relapse, not to mention the short term pain/suffering of that treatment.
In the end it felt like the most responsible course of action to take was, in fact, to go forward with the radiation. My final concern was weather or not my heart would be in the field of treatment which could put me at significant risk for cardiac damage; that's a big deal for me since I've got a family history of heart disease and it would really impact my cycling for the rest of my life. Call me short sighted, but it's just so much a part of me. That's my escape/therapy/etc.
Spoke with the radiation oncologist yesterday and got good news on the plan. The duration and dosage were even lower than I expected, the heart was completely out of the field, and there was minimal lung involvement. In fact, he said if the heart WAS in the potential target area he would likely have recomended against going forward. I was already fairly convinced but this sealed the deal.
So today I went back to do a dry run on the table. The machine was as described by other hodgkins patients. The procedure is quick and easy for each treatment. The main difficulty is that it's every week day for the duration. That's where the short duration comes into play. I've only got 17 treatments compared to a potential of 25. Much less taxing on my schedule since I'm back at work, now. When I spoke to one of the therapists afterwards she thought that by the time I noticed some of the short term side effects I'd be close to done!
So I get started Monday 17 treatments for a total of 18 Gy. I should be done by the end of the year.
Of course, I've found out on this journey that you're never really "done." But if your lucky, you wind up with a nice 40 year break!