Rest period

After a hectic stream of weeks, I have now got a couple of days rest at home with an upcoming visit to the hospital again on Jan 19th for a CEA test. This test gives a rough idea of the presence of cancer cells in the body; the more the CEA value the more the cancer in the body. (The last CEA done on Dec 18th showed a value of 7.64. This is a kind of OK value and the test was done just before the radiation.) So, with the CEA test coming up, hopes are high that the test shows a reduced value since the radiation is supposed to kill most of the cancerous cells in the liver! :) Until then, I am now on oral chemotherapy medication which is a stop-gap arrangement to reduce the risk of the spread of the disease.

CyberKnife completed

I have had my last dose of radiation through CyberKnife yesterday. (The total dose of radiation recommended was 2400 cGy spread over three days. Gray is the unit of radiation and is defined as one joule of energy absorbed by one kilogram of matter. I had thus received 2400 centi Gray of radiation!)

Though the entire was painless and non-invasive, it was cumbersome not to be moved for almost two hours in each session! A mild movement such as that of fingers and arms is fine, but any medium movement causes the robotic arm of the surgery equipment to stop and proceed which might end up in taking more time for each session! :)

Now that the CyberKnife is complete, I need to meet my team of doctors (radiation oncologists, medical oncologist and a surgical oncologist) tomorrow to discuss on the future plan of the treatment. The discussion might include such issues as the post-radiation medication, the time of the next PET/CT scan to know the response of the tumor to radiation and any thing more. Hope, this radio-surgery might have had a positive impact on my overall health. :)

CyberKnife started

After a few days of hectic consultations and tests, yesterday, I had my first session of radiation under CyberKnife surgery system. The session lasted around two hours and was completely painless, though it was a bit cumbersome not to be much moved during the entire session. (A mild movement during the session forces the robotic arm to stop since it cannot track the tumor!) There were no pre-requisites for the session except to have a Granicip tablet, an hour before the session.

The treatment plan for me was fixed for three days of pointed and focused radiation followed by an observation time of three months. (Yesterday's session was my first day.) Though this radiation-based treatment is somewhat similar to that of the IMRT-based radiation I had last year in Chennai, there are quite a few differences:

• IMRT affects the healthy tissues too, whereas CyberKnife is focused on the malignant tumors only
• IMRT radiation typically last for 4 to 6 weeks, while CyberKnife lasts for only 3 to 5 days
• The side-effects of having IMRT radiation are significant whereas there are minimal or no such side-effects in CyberKnife

I am excited and curious to see what CyberKnife would do to me in terms of the removal of the disease, but to know its effects completely I should wait for a PET/CT scan after three months, because the effects of the radiation would be slow on the tumors unlike those of the chemotherapy!

Planning scan done today - second step towards radiosurgery

I had a limited edition of planning PET/CT scan done today morning. The objective of this scan is to get the images with reference to the fiducials done as part of the first step so that the robotic surgery system could track the tumor's dimensions. Since the disease is now confined to only limited area (liver), the scan was done in a limited area without the usual oral contrast, but with only IV contrast of FDG. (For more details on how the usual PET/CT scan is done, see my earlier post.)

The whole process of scan today lasted around an hour and later my doctor Dr.Kumaraswamy, Radiation Oncologist, told me he would make me informed on the timing and other details of the radiosurgery treatment later today. So, I wait and look forward to the actual radiation sessions! :)

Getting ready for CyberKnife - a radiosurgery process and becoming a golden man!

Yesterday, I met Dr.Ajaikumar, who is the CEO of Health Care Global (HCG), the umbrella organization which owns Bangalore Institute of Oncology (BIO). Dr. Ajaikumar also heads the CyberKnife - the world's first non-invasive, whole-body, robotic radiosurgery system and is designed to treat tumors anywhere in the body with pin-point accuracy. During my meeting with Dr.Ajaikumar, we were accompanied by my Oncologist Dr.Niti Narang, Radiation Oncologist Dr.Kumara Swamy and Senior VP (Marketing) of CyberKnife, Mr.Tanjai Kapoor. The excerpts from our discussion with the experienced team of doctors here:

• since my disease is limited to only liver and a peri-portal lymph node near the liver, the radiosurgery has a higher probability of treating the tumors
• the tumor in the peri-portal lymph node is insignificant in the sense that it is currently less than 5 mm in size and is inactive. So, serious attempt will be made to target that tumor too during the radiosurgery.
  
• liver is one of the soft-tissues in the body and treating the tumors in the liver is a highly-skilled process. Also, since the tumors in the liver move with the respiration, it is more difficult to accurately trace the location of the tumors for any radiation based surgery technique. To do this accurately, hence, the CyberKnife technique involves implanting metallic markers made of gold in the liver so that the robot doing the radiosurgery can track and trace the location of the tumors accurately.
• the entire radiosurgery process may take between 3-5 days and I can be treated as an out-patient. This means that I need not get hospitalized!
• the radiosurgery process is completely painless and may take an hour per session per day.

After some discussion with my father, who came with me, I decided to go ahead for the radiosurgery as the next treatment. We then talked to Mr.Tanjai Kapoor regarding the financial issues of the process. A half-an hour discussion ensued and we were told that the entire treatment would cost us Rs.3.25 lakhs (this is after getting a good 20% discount!), which would include all the related scans and medicines. As a first step of the process, I was asked to get the gold-made metallic markers (called fiducials) implanted in my liver. This is a minor surgical process done under the local anesthesia. Yesterday afternoon, I went through this process of fiducials wherein three needles were used under local anesthesia to implant a total of five gold-metallic pieces in my liver. I suffered breathlessness for almost the entire day later because of this process. :( These markers would help the robotic system to accurately locate the tumors in the liver while treating them. The next step would be a planning scan to be done ten days later. Meanwhile, I was advised to be on a couple of antibiotics (both oral and IV) and on continuation of the oral chemotherapy tablets of Capecetabine. This planning scan would produce the images that would be for the robotic system to pick up and understand the structure and the location of the tumors during the actually surgery. So, finally, I have become now the golden man :) with gold-made metallic implants in my liver now! I trust the team of doctors in BIO for my treatment and I hope I would get the best possible treatment under their supervision! :D I hope with this radiosurgery, despite some suffering and difficulties, I would be free from the disease completely. :D