External Beam Radiation Therapy

“Normal Treatment,” Part II
(draft) 2015, Davd*

It’s November, the trees are bare, and there’s ice on the streets outside, but you’re looking up at a deep blue late spring sky with apple blossoms and green leaves around the edges. You’re flat on your back, on a slippery high-tech carbon fibre table, with your knees and lower legs supported by plastic frames to make it easier to lie stock still. The room you’re in has a door about as thick as the doors on bank vaults, but the lock is a lot simpler, and what it’s keeping inside is radiation, not money.

Your pants, underwear, and shoes are back in a locker maybe 100 feet from the vault where that slippery table and you are about to get zapped. Two technicians [techs for short] have positioned you on the table, laid a cloth over your belly and pelvic region, hurried out, closed and locked the door, and are now steering a very elaborate machine around your otherwise naked pelvic regions, by remote control. First it will take X-ray pictures, then figure the trajectory of the high-powered1 beam, and give the table a little jerk to make it line up with the figuring. I don’t know how much of the figuring is done by the machine and how much by the techs—who are on the other side of the vault walls so they don’t get zapped when the table and you do.

After the table jerks, usually in a minute or less, the machine begins to whine: That’s the attack intensity X-ray, and as the machine rotates around your pelvic regions, the ray shoots at the tumor from an ever-changing angle. The tumor always gets zapped while it’s whining; but other parts of your body, only briefly.

The whine lasts perhaps a minute—that’s the actual treatment. This whole big fuss and bother, hours of work for you and among the 2-3 techs and the various desk jockeys, a total of another hour or more, is “all about” that minute or so when it whines. But don’t move when the whine stops! Sometimes, not every time, the techs will want to measure something with you still in that same exact position. If they do measure, the’ll do so before they tell you that you may pull up those funny hospital pants—or move at all.

Then the table lowers to a little higher off the floor than the top of a coffee table, and they will want you to take a metal ring in one hand while you get off. You go back to that change room, get your own pants and shoes out of the locker, dress, and move on with your day… somewhat wearily, which leads to the warnings.

The first warning, methinks, should be that Fatigue is the commonest and usually worst “side effect.” Expect fatigue. If you’re not yet retired—a rather large fraction of prostate cancer patients are retired, compared with other cancer patients and even more, with the general population—you might not be up to doing a normal week’s work along with treatment. Plan to be slower and weaker than normal, even slower and weaker than “eunuch normal”, from some time in the second week of treatments, to a month or so, perhaps six weeks, after they end.

Why? Because radiation treatment is destructive, that’s why. The big elaborate machine is so big and elaborate, so that it can rather precisely aim attack-power X-rays at the tumor from a whole lot of different angles. The tumor always gets damaged; surrounding body tissues, much less—but some damage is done. Your body will give priority to repairing the damage2, and it will take a lot of energy, protein, and other nutrition. In other words, you are being selectively injured and healing the injuries will tire you badly. In still other words, you are taking a selective beating and getting over it involves several weeks of weakness.

Second warning: Expect austerity. A very common austerity is being forbidden to enjoy alcoholic drinks. Repairing the selective damage, puts some strain on your liver. Alcohol would add to the strain. So even if you’ve been able to have a few beers with your friends or your burgers, without it hurting you; even if you’ve been able to have a half bottle of wine with a good meal, no harm; that might not be the case while you’re in radiation treatment and for the fatigue weeks that follow its end.

(I don’t know nearly as much about chemotherapy as about radiation, because prostate cancer is less often treated with chemotherapy, than with radiation… plus, my treatments were in a radiation zone and those who got chemotherapy went to another part of the building. In the waiting areas, i talked with other radiation patients. What i heard and read, seems to say that a ban on alcoholic drink is more likely, and likely to last longer, if you get chemotherapy. What i’ve seen, away from the cancer hospital, is that the ban is not always obeyed.)

You will almost certainly be told to quit smoking if you do; and may also be banned from coffee. (Remember the neighbour who died of lung cancer this year? He was a regular cigarette smoker.)

Your modesty is going to be rather well ignored in the vault, much as it was in the biopsy. You get a change room about the size of a two-holer privy with a curtain instead of a door, to get out of your pants, underwear, and shoes, and a locker to put them in3. You get a pair of pale green or maybe bluish (they look sort ot like splash pants but i don’t think they’d last long in the woods) to cover your nakedness while you wait to be called into the vault. But once in the vault, you lie down on that table, pull down the splash pants, pull up your shirt and whatever’s under it, and they line you up using those tiny tattoo marks they made a few weeks ago.

You probably won’t suffer claustrophobia—the vault is pretty large, larger than most bedrooms, and the big machine doesn’t crowd you like CAT and MRI scanners can. You can see, not daylight but at least some kind of light, and ceiling and walls, past gaps in the parts of the machine. I suppose some psychologist figured that the late spring sky graphic—not all treatment vaults have them—will help you relax; at least, it is what you might see if you were lying on your back under a skylight, at that time of year. But the vault doesn’t have a skylight, it has another level of the cancer hospital above it… and probably, radiation shielding between its ceiling and the floor upstairs.

You might suffer a more common discomfort—“having to go.” The directions for pelvic radiation treatment include “A full bladder and an empty bowel.” If you do what’s natural, plus the toilet training you had when you were two, you’ll empty both at once if the bowel has something to empty. SO—part of the whole treatment scheme, will be Advanced Toilet Training, and that’s a big enough business that just to tell you what it’s about—not actually doing the training—will take a separate post.

Notes:

* I label this blog “draft” at posting, to allow for possible technical improvements and corrections by readers. It is written less personally than the previous two, but as posted, is based more on my experience of Radiation Therapy than on technical knowledge—so to be prudent, i allow for the possibility of a mistake.

1. “High-powered” is relative; the machine is capable of at least two levels of tumor-attacking intensity. At the highest intensity, both doors of the vault are closed. At the lowest “attack intensity”, only the outer door is closed. In between, i don’t know the details, and anyway, you can’t see the doors from flat on your back on the table.

2. Tumor cells, i read in one of those many handouts, cannot repair themselves as readily or as well as normal cells, so in addition to getting more damage than surrounding body parts, the tumor has a disadvantage in its repair efforts.

3. I suggest you carry a small lock. During the time i’ve been receiving treatment, at least three patients had their clothing stolen—and if they’d left wallets in their pants, the clothing was found later somewhat messed up, but the wallets were gone. The techs were saying “lock up your clothes, and to be really careful, carry your wallet and keys into the vault with you.” There was an old chair off to the side of the vault to put personal effects on; i carried mine in a cloth bag a little smaller than most shopping bags.

 

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About Davd

Davd (PhD, 1966) has been a professor, a single father keeping a small commercial herb garden so as to have flexible time for his sons, and editor of _Ecoforestry_. He is a practicing Christian, and in particular an advocate of ecoforestry, self-sufficiency horticulture, and men of all faiths living together “in peace and brotherhood” for the fellowship, the efficiency, and the goodwill that sharing work so often brings.

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