Right in Time

I finished 5 rounds of radiation on Friday. My appointment was at 4:15 every day at UPMC Altoona, a 50-minute drive each way. Leland went with me four days, and my friend Kim accompanied me on Friday. Thank you both! The first day was the most challenging: we had to wait an hour, and during the procedure, my arms were in a very uncomfortable position, so much so that my fingers started going numb. I had to lie still on my back with my arms held out behind my head for about 40 minutes, with a very short break in between sessions, when they switched from treating the left lung to the right lung. The next day they made an adjustment that made it a lot more tolerable.

Thankfully, I had no fatigue or other side effects. The next step is getting CT scans in 2-3 months. SBRT radiation is highly effective, so I’m anticipating good news. We are also grateful for the 3 families from church who brought us dinners last week. It was a relief not to have to make dinner when arriving home after the appointment.

Since we were going to Altoona anyway, Leland and I did something we've always wanted to do: visit the famous Horseshoe Curve. This National Historic Landmark is one of the 8 engineering marvels of the world. In the early 1850s, engineers found a way for trains to pass through the Allegheny Mountains, and Irish immigrants were brought it in to do the work. The Curve was so important in transporting freight during WWII that Hitler sent 8 saboteurs to destroy it in 1942. They were all caught before they could do any damage. We were lucky enough to see 4-5 freight trains, each taking 11-13 minutes to pass through. Lily's volleyball club (Horseshoe) is named after the Curve.

The curve is behind us; you can see both ends of the same train.

People have been asking what radiation – and my radiation in particular – entails. I’m glad you asked! I have been learning about it myself. Let's nerd out about stereotactic body radiotherapy (SBRT). This highly precise radiation is often used to treat small lung cancer tumors, as well as some other cancers outside the brain. SBRT was used to treat the small “indolent nodules” in my left and right lungs.

According to a Memorial Sloan Kettering article, systemic therapy (like the Tagrisso targeted therapy I've been taking for 4+ years), can become less effective over time. “In some people, the treatment is still controlling the cancer in most places, but a small number of areas have begun to grow. This is called oligoprogressive disease. For these patients, the critical question becomes: Can radiation treatment stop cancer growth at this handful of sites so that systemic treatment can keep doing its job everywhere else?” Research suggests that adding SBRT can keep cancer under control much longer compared to targeted therapy alone. 

UPMC Altoona acquired this machine just 2 months ago! They typically cost $4 to 5 million. It looks like equipment that you might see in space exploration. It’s truly next-level. 

The bespoke black mold was created to keep my torso still. My hands held onto those little black bars.

The machine (top, bottom, and "arms") revolved around me like satellites orbiting the earth. Here’s the problem for lung cancer: tumors are a moving target because they change position when you breathe. So how can you be sure that the radiation is hitting cancer cells, not healthy cells? The machine uses 4D imaging to map and track how the tumor moves over time, and then adjusts the radiation beam or pauses delivery based on breathing patterns. (Time is the 4th dimension.) According to an NIH article, “Systems correlate external breathing motion with internal tumor position to build a real-time predictive math model that guides the radiation beam.” 

The UPMC radiation technician pointed out that the machine only delivered radiation when I finished exhaling. (I.e., the little breathing monitor taped just above my belly button was at its nadir.) Then the machine parts would rotate. I would exhale, and the machine parts would move again. I quickly realized that my breathing was controlling the machine’s movements! That was a powerful feeling. I pondered breathing more quickly so I could finish the session sooner, but thought better of it. 

At one point during my Thursday session, Lucinda Williams’ song, Right in Time, came up on my playlist: “The way you move, it's right in time. It’s right in time with me.” That seemed apropos. The SBRT machine was moving right in time with me.

To see how SBRT works in action, watch this video. Start at 20 seconds, stop around 1:06. I hope none of you need to get radiation in the future, but if you do, I hope it’s SBRT.