Chapter 37: Radiotherapy Treatment

“During the development of the whole-body CT scanner, it became clear that the availability of an accurate cross-sectional picture of the body, the CT 'slice,' would have an important effect on the precision and implementation of radiotherapy treatment planning.”
Godfrey Hounsfield

It’s been six weeks since my pleurodesis operation to remove the fluid from my lungs. Since then I’ve had plenty of rest, three immunotherapy treatment sessions (Nivolumab), three clinics with Dr. Wheater (where he has upgraded my pain relief drug of choice from co-codamol to 30mg of morphine sulphates) and two double blood transfusions, but I’m still feeling like shit. What’s more, I think I’m now starting to feel even shittier on an almost daily basis. The side-effects of the chemotherapy (pazopanib) have at least all worn off now, so I’m assigning full responsibility for my current batch of ails and maladies directly to the cancer itself. In addition to my temperature fluctuations, shivers, sweats, extreme lethargy, perpetual tummy pain, considerable weight loss (I’m not eating much now), I’m also now getting pain in my right hip again. 

Last time I stopped taking my chemotherapy and developed pain in my right hip the subsequent CT scan revealed that the cancer had spread to my right hip bone. The pain did ease when I went back on the chemotherapy, but the pain is back again now with a vengeance now that I have finally stopped taking the chemotherapy, and the immunotherapy has so far proved to be of bugger all use in curtailing any of my cancer related symptoms. When I had pain in my hip before Dr. Wheater mentioned that radiotherapy may well be appropriate to specifically target the cancer in my hip bone. However, he also said that it would not be possible to have the radiotherapy treatment at the same time as the chemotherapy treatment, and we were both reluctant for me to take a break from the chemotherapy whilst it was still working. Now that the chemotherapy has stopped working and I have had to stop taking it, I can see no reason why Dr. Wheater can’t recommend me for some radiotherapy treatment on my hip, and that is indeed precisely what he recommends at our next clinic. 

An appointment letter for my radiotherapy treatment arrives in the post a few days later and it seems to include an agenda for a full fun-packed day of treatments and appointments with a free lunch thrown in for good measure. Sad as it may sound, but life has now got to the point where I’m actually quite looking forward to my next hospital visit. I arrive at Southampton Hospital nice an early for my appointment just over a week later and make my way downstairs to the radiotherapy department. I announce myself to the receptionist who hands me a pre-prepared pack of information detailing all of the day’s activities and a single sheet with an agenda and timings of the day’s events. The first item on the agenda is a meet and greet where I get to meet my consultant radiotherapist and the various other practitioners I will be seeing today including a dietician, a specialist liaison nurse and an occupational therapist. I talk everyone in the room through my cancer journey to dae so they are all up to speed with my condition and the treatments and operations I have had so far. 

After I’ve answered a few questions and everyone has explained what services they can offer, I head off for a separate meeting with the radiographer who talks me through the actual radiotherapy procedure. Radiotherapy is not quite as the name implies, my cancer will not be bombarded with The Archers Omnibus or Women’s Hour, even though I can see a very plausible mechanism as to how cancer cells may choose to destroy themselves rather than subjecting themselves to Thought for the Day. Clumsy religious mumbo jumbo shoehorned into the yesterdays news and drizzled with Ann Atkins most tiresome platitudes although seemingly enough to drive anything into remission is not in fact how radiotherapy works. Metastases in the bone however do apparently frequently respond quite well to being accurately targeted with a few carefully aimed microwaves, and this is what lies in store for me this afternoon. I’m told that the process itself should be painless, but the pain may increase after the procedure for about a week or so before things start to improve. As well as explaining the mechanisms, procedures and pain prospects, my radiographer is also keen to set my expectations. When I first started my chemotherapy treatment last year my oncologist was also very keen to ensure my expectations were hopeful but not inappropriately optimistic. It was made very clear that the chemotherapy would never cure my cancer but that it would hopefully give me a little more time. Once again, the radiotherapist is keen to stress that the purpose of today’s treatment is not necessarily to remove the cancer, or indeed to extend my life any further, the purpose is to simply ease the pain to make me more comfortable. I’ve not been terribly comfortable of late so I’m all up for being made a little more comfortable and my expectations are not unrealistic, so that’ll do for me.

The first stage of the treatment is a radiotherapy CT scan to pinpoint the precise location of the cancer in my hip so they can exactly target the microwaves they plan to zap it with. I’m strapped to a table and scanned and then I’m tattooed. In order to ensure that I’m in exactly the right position again when I receive the treatment, two single pixel tattoos are inked into my pelvis so I can be correctly realigned with them later this afternoon when I have the actual treatment.

After my scan I have an appointment with my dietician. Tori is also very keen to have a word with her to get some suggestions to try and get me to eat. She gives us some very useful scientifically evidenced dietary advice as opposed to the current food fashions and fads favoured by far less qualified nutritionists. It’s not quite the advice most people get as rather than limiting my calorific intake, due to my current condition I am recommended high fat foods and more snacks. Tori agrees to bake me some sausage rolls for snacks as I’m not terribly keen on shop bought ones and the dietician also recommends a few more tasty items to stock the fridge with. I thank the dietician for her advice and tell her how happy I was to speak to registered dietician and not a nutritionist. She smiles and says that she was was very happy to talk to someone who understands the difference.

The main even of the day however the radiotherapy treatment, and after lunch I make my way to the treatment room. I mount the table, place my feet in the stirrups and the laser guidance system moves me into the exact position by lining up with my nice new tattoos. I’m a little concerned that I’m about to start with one of my shivering attacks and I’ll end up shaking about all over the place while they’re trying to aim their killer microwaves at me. The radiographer assures me however that I’m suitable still and all will be fine. There is a humming noise as the treatment starts but I feel nothing. After about ten to fifteen fairly uneventful minutes the humming ceases and I’m informed that the treatment is complete. Piece of cake.