Palliative Radiation Therapy, a Mid-Treatment Snapshot
We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.
Radiation is often thought of as a curative treatment for various types of cancer. However, for Stage IV lung cancer, radiation may not be considered an option for many patients. When a cancer has spread far and wide, the general approach tends to be chemical, with drugs designed to reach cancer cells wherever they may be. Surgery or radiation may be used to treat part of the cancer, depending on the patient’s specific case, or may simply not be used at all. When I began my cancer treatment, radiation was definitely off the table.
Considerations for radiation therapy
The rationale for avoiding radiation on my primary tumor was two-fold. One, it would do unnecessary harm to the surrounding tissue. Two, by leaving the tumor alone, we would be better able to monitor the success of my chemotherapy. This made sense at the time since the various metastases throughout my system were either difficult to monitor (being inside bones) or possibly false-positives (inside several organs). And the chemo was fairly effective at reducing or eradicating numerous metastases. However, with time, some resistance to the chemotherapy began to develop.
Although I switched to a targeted medication, I have not regained the level of treatment success that I enjoyed with chemotherapy. While the primary tumor still shows that progression has been kept to a reasonably slow pace, this targeted treatment has not completely stalled out my cancer’s march. Recently, a new development brought this somewhat painfully to my attention. I say that without a shred of irony.
A new, unwavering pain
Over a period of several weeks, my sciatic nerve had begun giving me issues. Since I suffered from back pain frequently in the past, I began exploring ways to mitigate the discomfort. I tried modifying my habits, stretching more, and eventually taking various painkillers to get through my days. By the time I had an MRI to diagnose what was causing the pain to worsen, I had to take prescription medication just to sleep at night. I was convinced that I had a slipped disc, possibly weakened by the cancer that had taken up home in my spine. But that did not quite jive with the apparent source of my pain: a muscle in my lower back.
The MRI displayed that there was a mass in that muscle, pressing up against the sciatic nerve. It appeared to be a new metastasis, an off-shoot from an area of cancer still active in my lower lumbar region. The quickest way to relief was radiation, and I could not get started quickly enough.
Prepping for radiation
I have heard plenty of horror stories about radiation, and it only took about a day before people started offering up their own versions of why my life was going to be so hard for the coming weeks. But the truth was, this radiation would be highly targeted and, for the most part, avoid organs that might be especially sensitive. My medical team downplayed the side-effects for me but encouraged me to be ready with medicine to handle them if they occurred.
I am now halfway through the ten treatments designed to alleviate this pain. The small metastasis in my muscle and the offending area of activity in my spine are both being treated. This way, we kill off the tumor that is causing the pain and kill off the cells that led directly to its creation, thus preventing recurrence of the same problem while reducing my overall cancer burden.
The first three sessions did cause me to vomit, once each time, but without any real residual nausea. By the fourth session, I had no adverse reaction at all. (I chose not to take my anti-nausea drugs because I wanted to see if my body acclimated to the treatments — but I simply forgot to take them for the fourth treatment because I had taken the weekend off and felt great. It was just simple luck that my body had, in fact, acclimated by then. And after the fifth session, I continue to have no issue with throwing up or feeling ill at all.)
Finally finding relief
But the most amazing thing was the almost immediate relief I began experiencing after my first session. While there is still some pain, even after five sessions, it is considerably less. Before treatment, I was taking between 6mg and 8mg of hydromorphone throughout the night just to be able to sleep. I was able to cut that in half after one treatment. After three treatments, I was down to 2mg at bedtime and not taking anything again until the morning. Today I skipped the morning dose altogether. By the end of the week, I hope to be off the medication entirely.
Radiation is an extremely effective means of spot-treating cancer. The more patients I talk to about it, the more impressive it seems. I have numerous acquaintances who successfully treated brain metastases this way, and the technician who runs my machine has benefited from radiotherapy for her own stage IV lung cancer condition.
While the first few days were a little tough, the meager feeling of unwellness was readily offset by the pain relief and greater ability to sleep. The horror stories I heard were unfounded, and no doubt were based on outdated technologies or extreme cases. For me, standing right in the middle of the experience, I can state unequivocally that palliative radiation has had an immediate positive effect on my life.