SBRT - Decision Made!

Well, where did you stand?

Did you guess "yes, she'd do it?"

Or "no, she wouldn't?"

Oh come on, you people know me better than that.  Of course I'm going with the latest and greatest in technical advances - I am one who got her iPhone 1-5 on the first days available, after all.  (And, the 5 is already full, darn it, I knew I should have gone with the 64 gig.)

After sort of speaking to my oncologist, who said it wasn't his specialty but that chemo was destroying my bone marrow and it couldn't take much more and he thought this was my best shot, and then talking to the Radiation Oncologist, who assured me that he thought I would do quite well, and that he and his team had discussed my case and he thought I would not be left worse off than I am now (my big fear) and who answered my questions, I decided to do the SBRT.

So here is the schedule so far:

June 7th, I have Fiducial Insertion.  (No, that does not mean I have a hot date with Donald Trump).  They will be putting little pure gold coils into the liver around the tumor, which will be super fun when I go through security at the airport.  These coils will help track the tumor through my breathing cycle so the machine doesn't send a shot of radiation through the wrong place when I inhale.   The fiducial marker insertion, he said, would feel just like a liver biopsy.

Uh oh.

I got a copy of the surgical report after my biopsy and they had written right into the report that I had experienced undue pain, so it's not just my word.   I am going to contact them ahead of time, ask them to read it and see what they had given me and then up it tenfold.  I'll tell them that I want more medication, better medication, different medication - something, anything, not to feel that I've been stabbed again.  In the ensuing years since that biopsy and today, I have been put on pain management medication, have developed certain tolerances, and whatever didn't work then surely won't work now.  

I know this must be done but they also must help me manage it better than the last time, don't you think?  Somewhere in the patient's Bill of Rights there has to be something about not stabbing a patient's vital organs without proper medication.

June 17th, after the fiducials settle, I'll have a PET/CT scan.  Ho hum.  After that, they start the planning process, which I'm sure includes very technical stuff involving Gy doses and positioning and the like.  I read that they create some sort of foam/bead bed that is designed to your body and keeps you in the same position each time, which should be fun.  Maybe I can make a "bead angel."  I will have five treatments, or fractions, probably starting the last week of June.   Then, I'll be done and we'll wait to see if it breaks up the tumor, via another scan in a few months.

Of course, it is possible that at this point, after the marker placement and scans they could say I am no longer a candidate - they may see cancer encroaching on the portal vein or something else disturbing.  

But if it's a go, here are the possibilities:

Best Case "One Can Always Dream for a Miracle" Scenario:  It destroys my tumor, and nothing ever grows back. I'm cured of metastatic breast cancer.  That happens approximately never, but I could be one of the first, you never know.  Here is one study where they called the woman cured; the only thing is, they only followed her for only two years.  That's one way to get the result you want. "Hey, we saw this 70 year old dude who didn't die in 2 years, that meant he lived forever!"    Personally, I wish I knew how she was doing now and if she's till "cured."   I'm guessing no but I'm a cynic who has never heard of anybody surviving this disease to live a normal lifespan.

Next Case, Most Likely, Good Scenario: It destroys the tumor for a while. I get to go off chemo for a year or two. (Although will still be on Zometa and Herceptin and ....perjeta? Not sure about that one.)     I get a break, get to do the things I want to do with my family like go college shopping with my son, see him graduate, decorate his college dorm room, and do all that with some modicum of energy and ability before the disease comes back and I must start chemo again.   This is what has been published about SBRT for oligometastatic breast cancer:    4-year actuarial outcomes were: overall survival of 59%, progression-free survival of 38% and lesion local control of 89%. 

Bad Case Scenario:  I do all this but it doesn't kill the tumor and I'm still on chemo and now with a radiated liver having to process these drugs.  I pee florescent and we have to hire guys from the Fukushima Daiichi Plant to clean our bathroom.

Worst Case Scenerio:  Something goes wrong, a beam hits the portal vein, liver function disappears and this blog finally ends.

A moment of silence for that.

So, there you have it.  Except for the fiducial placement, I'm okay with this plan.  It is a relief to have made the decision, whatever happens.


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