The Big Radiation Meeting

Met with Dr. Sinesi (radiation oncologist) today, and things are looking good. My CT scan of the neck and chest are clear. Dr. Sinesi showed us the comparison between the CT scan in October and the one I just had two weeks ago. There is a definite change in the scan, and we saw where the mass was before and the fact that there are no other masses in the scanned region. This was very good news. He went over the proposed treatment plan with us. He is going to use IMRT (Intensity Modulated Radiation Treatment) over my lower jaw and neck area - both sides. My type of cancer is known to spread to either side of the neck - the fact that Dr. Debo (ENT) didn't see any other unusual masses in my neck region, means that the cancer cells are on the microscopic level and what is considered low grade cancer. So the radiation is going to be directed at the left tonsil and specific lymph nodes and local area. The IMRT allows Dr. Sinesi to precisely tailor the radiation intensity and field to minimize the damage to the surrounding tissue as well as reducing the side effects. The plan is for 32-36 radiation fractals (sessions), we'll know the final number next week, given daily M-F. Like chemotherapy, the effect of the radiation is cumulative, and if for some reason, we cannot make a session, it will just be tacked on to the end. The time between session gives the body a chance to repair the healthy cells.
After talking with Dr. Sinesi, we met with Bridget - radiation therapist, who constructed my mask. Marjie was there and the pictures document the process...

The whole process took about an hour. She had me lay down on the radiation table, placing my head on a clear plastic form, and put clamps over my shoulders to open up my neck area.

Once I was positioned on the table, she placed this net-like form over my head.

This mesh type material was moistened and heated then she placed it over my face and neck, pulling up on the nose area to ensure I could breath easily and then she tried to expand the neck area so that it wouldn't be too uncomfortable.






The key placement of the mask is the placement of my jaw.


After the mask hardened, Bridgett then took another series of CT scans, so that Dr. Senesi can make a 3D model of my head and neck to precisely direct the IMRT.

I have two more appointments to ensure the mask fits properly and the markings on the mask are correct for the treatment, before we start the radiation treatment on the 13th.
So what all this means in a nutshell is that I will start my radiation treatment on the 13th of February and should be finished on the 28th of March. Radiation will be given every day M-F and I'll get a new chemotherapy drug, Carboplatin, each Wednesday after my radiation. Thankfully the carboplatin is a much lower dose than I had been getting in the past and should not be getting all the nasty side effects that I had been experiencing earlier. The whole purpose of the carboplatin is to sensitize the cancer cells, which makes the radiation even more effective.
After we were done with the mask, Bridgett gave us a whole bag of samples and information to help with the radiation process - Udderly Smooth Udder Cream, Salagen to help with the dry mouth, lipbalm, Aquaphor Healing Ointment, and Juven Therapeutic Nutrition Drink. The creams are supposed to help when my neck gets red and dry from the radiation. Bridgett then took us to meet Ellie, a patient navigator. Ellie is a stage 4 cancer survivor, who decided that if she survived this ordeal, she would help others through the process and now is a patient navigator, essentially if we had any question or hit any stumbling points, she would help us find the answers.
After finishing up at the Radiation Cancer Treatment Center, it was a quick trip to Burger King for a Wopper, then off to Dr. Atienza's office. Over the past two weeks, my legs have been really sore, especially when I would be sitting for a long period of time. About a week ago, I started noticing that my socks would create indentations on my legs, and that my ankles would appear swollen. This past weekend it had gotten worse so I called Dr. Atienza 's office on Monday, and finally talked to Kathy (Dr. Atienza's nurse) yesterday...we think the swelling may be due to an increase in my salt consumption (Gatorade, salting all my food, etc). So, I've stop drinking Gatorade and am trying to minimize my salt consumption. To be on the safe side, Dr. Atienza ordered up a full blood and urine scan. He checked my heart and lungs and said they appear to be good. Hopefully the swelling is just from the salt. Other than that, things are looking good. I am ready to start and get through the radiation process, hopefully I will not have to use the PEG, but it is there if needed.