Stereotactic Radiation - Decisions

My last oncologist appointment was interesting.  We were discussing how difficult Gemzar is for me and how my blood doesn't seem to recover anymore.   My doctor stood up and said, "I'm going to make a phone call about you" and left the room.

I was left wondering who he was going to call about me.   President Obama to discuss me in context of health reform?  Angelina Jolie in the context of prevention?  His wife as an "I can't believe my patient said this" conversation?

Who?

He came back in and said that he called a doctor in Radiation Oncology to see if I qualified for SBRT, which is short for Stereotactic Body Radiation Therapy.  He hadn't reached the doctor but said he'd try again and get me a consult.

SBRT is like Gamma Knife, a more common term that you might be familiar with.  There are several different names for it, but basically, it is a highly focused beam of radiation designed to kill tumors.

Killing tumors sounds so easy, doesn't it?  

I wish.

Within a couple of days, I got a call for a consultation.  The radiation oncologist and I had a nice chat about my history, as well as some mutual friends we share,  and then he said he thought that I would be a candidate, my tumor is the size they like, but that he would meet with a group of doctors and discuss my case.  They would contact me in about a week.   He did say that because my tumor was so close to the portal vein, "very bad" things could happen, and also said that it was "risky."  He explained the process and then he handed me a tri-fold brochure and introduced me to his assistant, whom I am to call with questions - and left.

I figured I had some time to research this and talk to others who may have had it and get some kind of idea whether this is in my best interests, or if it's just going to make me weaker.  Weaker, at this stage, would not be good.  I am having whole days where I can't get out of bed anymore.  I am not sure my body can take any traumas.

But, the very next day, I got a call for an appointment to insert something called "fiducials" into my liver which helps them track the tumor through breathing movements.  (By the way, these fiducials are appropriately named - they are pure gold.  I will have a very valuable liver.)  That appointment is June 7th.

Clearly, I had misunderstood the intent of the consultation and what was to happen.  In the doctor's mind, it was a third date,  and in mine it was a handshake in the street with the promise of coffee later.

In the mail today, I got blood work requests and surgery day instructions.

Too fast!

Because I thought that nothing would happen until my case was discussed at the tumor board meeting, I didn't ask many questions, and yet things are moving on very rapidly, and I still have not entirely decided whether I want to do this or not.  As it turns out, I do have many, many questions about this.

Even googling and reading real literature and journal articles doesn't help me, as just about everything I find has to do with HCC or colon metastases.  Not only do I have breast cancer, but I have had a liver resection already so that plays into this decision.  Have they ever done this on somebody with half a liver?  The cancer is near the portal vein too, which is why he said this could be dangerous.   One cough and I could be left with no liver function.

It really could go very badly.

Let's keep up hope though, and say it is successful and does kill the tumor.  I could likely be off chemo for a while, which would be amazing.  Maybe I could even have a period of normal living again.  Maybe I could travel, visit friends and family and knock some things off my to-list.  Maybe I could just do normal things like cook and eat.  That would be incredible.

As we all know though, even with success, cancer will come back, and I'll need to be back on chemo at some point.  Will a radiated liver be able to handle the chemo that is to come?  Can they really be precise enough to target only tumor and leave the liver alone?

What about the resection - how does that play into it?

So I guess another date is in order because I don't feel I have enough information to make a good decision.

Back in the early days of metastases, cutting out half my liver wasn't something I even questioned.  I feel very differently now.  That surgery did me no good and I now know that things can and do go wrong in these cases, even in the hands of experienced professionals.

Do I want to risk what little life I have left?

In the past, I've had trouble deciding which pair of shoes to put on in the morning, or what kind of sandwich to get at Subway.....and now this is the kind of choice I must make.

How on earth do you make a decision like this?