Blogging in B Minor

Just a quick post and update. I started radiation yesterday and then followed that by chemotherapy last night using the drug temodar. The radiation was fairly uneventful. The cumulative effects of this treatment are not supposed to show effects until week 2 or 3 and then again in weeks 5 and 6. In terms of the chemo, I’m using a drug called Temodar. It’s specifically geared towards an astrocytoma and oligoastrocytoma which are two types of gliomas. The pathology returned from my biopsy from the surgery on the 29th of June was a grade 3 oligoastrocytoma. The most notable side effects of the chemo are fatigue, primarily caused by the dip in red cell count the chemo causes and nausea which is counteracted by using a medication called zofran, an anti-nausea medication. From the radiation standpoint, I am receiving something called IMRT radiation, or Intensity-Modulated Radiation Therapy.

Intensity-Modulated Radiation Therapy (IMRT) is an advanced type of high-precision radiation that is the next generation of 3DCRT.(Galvin et al 2004) Computer-controlled x-ray accelerators distribute precise radiation doses to malignant tumors or specific areas within the tumor. The pattern of radiation delivery is determined using highly-tailored computing applications to perform Optimization (mathematics) and treatment simulation (treatment planning). The radiation dose is consistent with the 3-D shape of the tumor by controlling, or modulating, the radiation beam’s intensity. IMRT also improves the ability to conform the treatment volume to concave tumor shapes, for example when the tumor is wrapped around a vulnerable structure such as the spinal cord or a major organ or blood vessel. In my case, the tumor is straddling the motor strip so the protocol is excellent. The radiation dose intensity is elevated near the gross tumor volume while radiation among the neighboring normal tissue is decreased or avoided completely. The customized radiation dose is intended to maximize tumor dose while simultaneously protecting the surrounding normal tissue. Because of this, IMRT allows for higher radiation doses to be delivered to the tumor while sparing healthy tissue as compared with conventional radiation therapy techniques (2DXRT and 3DCRT). This in turn results in better tumor targeting, less side effects, and improved treatment outcomes than even 3DCRT.

3DCRT is still used extensively for many body sites but the use of IMRT is growing in more complicated body sites such as CNS, head and neck, prostate, breast and lung. Unfortunately, IMRT is limited by its need for additional time from experienced medical personnel. This is because physicians must manually delineate the tumors one CT image at a time through the entire disease site which can take much longer than 3DCRT preparation. Then, medical physicists and dosimetrists must be engaged to create a viable treatment plan. Also, the IMRT technology has only been used commercially since the late 1990’s even at the most advanced cancer centers so radiation oncologists who did not learn it as part of their residency program must find additional sources of education before implementing IMRT. In my case, I have a cutting edge team in the Neuroscience Institute here in Sacramento, a BrainTumor Center, and they not only have the team but also state-of-the-art equipment including these radiation machines as well as a 4-year-old Gamma Knife machine that is one of the best in the world.

The chemo went great last night. I took the pills around 10:30pm which were preceded by the zofran by about 1/2 hour and I went to sleep. I had minor nausea this morning and had a breakfast and all is well. So the next hurdle is to see how the cumulative effects are, if any. It is a good sign how I responded last night so I’m happy about that considering I am taking this every day for 45 days and am having radiation treatment 5 days a week for the 6 week period.

That’s it for now. More to come. Again, I appreciate the support and prayers from all of you. Thank you so much. Rachael and I cannot thank you enough.

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