Still No Radiation Plan

We met with the radiation oncologist today to figure out a plan. At this stage of the game, we should know better. You can't just get a plan with one appointment. There needs to be tests, and scans, and labs, and more appointments before you can get a plan. Even though we know that is how the process works, it is still frustrating.

Like we anticipated, the two options are Cyberknife and whole brain radiation. The choice is not left up to us, but rather to the Brain Tumor Board. In order for the Brain Tumor Board to even review E.'s case, they need the information from a detailed MRI. Like we were originally told, Cyberknife was not an option to treat the two tumors because of their large size. The Brain Tumor Board now needs to review the size of the cavities left behind. Typically, once a tumor is removed, the cavity left behind shrinks in the healing process. If the cavities are now small enough, E. may be eligible to receive Cyberknife versus whole brain radiation.

According to the literature given to us by the radiation oncologist, Cyberknife definitely sounds like the "easier" and "better" of the two options. Cyberknife delivers high doses of radiation to the tumor (or tumor area) via multiple beams that enter the body from different angles. This makes it possible to "concentrate" the radiation at the point of beam intersection while giving the rest of the brain only a small overall dose. The precise accuracy of Cyberknife minimizes the risk of harming surrounding healthy tissue, and as a result, larger and more effective doses of radiation can be administered. Cyberknife treatment for brain metastases generally consists of three treatments, or sometimes five. The side effects of Cyberknife are usually minimal and the period the patient must be on steroids is short (usually only during treatment and for a few days after). Another benefit to Cyberknife is that a patient can get Cyberknife now and can always get whole brain radiation later, if needed.

Whole brain radiation, on the other hand, radiates the whole brain. (Go figure. That must be why they call it "whole brain radiation.") Whole brain radiation would be given daily over the course of three weeks. It also requires steroid use for about a month. (Steroids help with brain swelling and edema, which is good. But as we all know, steroids make blood sugar levels go wacky, which is not good. Steroids also have their own side effects, which are tough for some people to tolerate.) Whole brain radiation typically affects cognitive skills ... short term memory, mathematic calculations, word recall, etc. Often patients who receive whole brain radiation are not quite as "sharp" as they were. This concerns E. greatly.

So what's the next step? E. is scheduled for a "detailed" MRI on Tuesday afternoon. (I thought all MRI's were "detailed," but they made it sound like this one was more "detailed" or something.) The Brain Tumor Board will then meet on Wednesday and we are hoping they will review E.'s case. For either form of treatment, E. will also have to have another CT scan. He will also have to have a mold made of his face ... some sort of heavy netting material that forms to his face and hardens ... it also extends past the sides of his face and will hold his entire head in place for each treatment session.

We will then meet with the radiation oncologist again. To come up with a plan.

I need a plan. I hate not having a plan.

(Oh, and just to let you know ... that "really quick" appointment wasn't really quick. Even though the appointment was scheduled for 8:30, E. was still 20 minutes late to his 9:30 physical therapy appointment.)

S.