Radiotherapy

From September to November of 2006, I had a six-week course of radiotherapy to the right side of my neck, as part of the treatment for my Adenoid Cystic Carcinoma. This page reproduces, in edited and expanded form, the blog posts I wrote documenting the process.

Preparation

This week, I had my perspex shell made and fitted. It will keep me in exactly the same place for the 30 radiotherapy sessions.

The process was somewhat like the one described in Wikipedia's entry on Lifecasting. I went to a special Mould Room at the hospital, and lay flat on a special table with my head tilted as far back as possible, so important stuff will stay out of the beam. My head and neck were smeared with vaseline, then (apart from my face) covered with blue alginate gel and plaster of paris bandages to add strength. After five minutes of setting, the whole thing was peeled off.

I then went home. While I was gone, they filled it was more plaster of paris to make a bust, and the reversed it again by vacuum-moulding a plastic sheet around the bust. The result was trimmed, and a hole was cut for my face. Two days later, I returned for a second fitting. With the addition of extra shoulder restraints and clips, they can use the resulting shell, which fits me exactly, to pin me to a table in such a way that I can only move a couple of millimetres each way. Impressive :-)

They immediately put that ability to use in the Planning Suite, where they pinned me down in a test machine and spent half an hour moving me about and making various marks on the shell, to ensure that they could get me back into that same position repeatably. You can see these marks in the picture; the red outline is the treatment area. The black cross on the white background is the NRP - Neck Reference Point - which is used to position me precisely.

Treatment

Start of Week 1

I started my radiotherapy course today. Here's the "before" photo, warts and all :-) I'll post a new one each week to document any changes. The most obvious side-effect will be to my skin; I anticipate ending up with a very bad case of sunburn. However, I'm told this will only begin to appear after two weeks.

Just in case it's not obvious: the treatment is to the right side of my neck, the one with the scars.

Start of Week 2

Here's what I look like after one week. There's not too much difference from last week. It's not sore yet, although I am now "aware" of my neck during the day, if you see what I mean.

At the beginning of this week, most of the shell in the treatment area was cut away, leaving only sufficient to make sure it keeps its integrity. This is because the shell slows down the beam, causing more of the radiation to affect the skin. So I can expect the pattern of remaining shell parts to appear on the skin in the form of darker areas.

I've been given various bits of advice about taking care of my skin. One of them was "use an electric razor; don't wet shave". (Presumably that's before the hair stops growing!) So I bought a battery-powered electric shaver. Where have these things been all my life? They are so convenient. I can stop paying the Gillette Tax every few months. :-)

Remember, folks, if you go into a business giving away the razors and selling the blades, watch out for the person who invents the bladeless razor...

Start of Week 3

Two weeks gone, and the redness is beginning to be noticeable. I can now see the outline of the treatment area on my chest. This is most obvious on the part out of shot, but you can vaguely see the line coming over my shoulder and down past my adam's apple.

Oh, and I've had a haircut :-) I figured it was best to have one before the area got too sore.

Start of Week 4

Two images today, for your viewing pleasure - as you can see, the rather precise nature of the beam has resulted in the hair on the back of my neck falling out in a very defined pattern. It's also easier to see the skin redness on that photo, particularly on the lower half of my ear and the lower part of the back. I expect to lose the rest of the hair in that region (and on my chin on that side) in fairly short order; the question now is: do I shave the other side to match? :-)

I had a minor sore throat this week, which started on Monday but has, rather surprisingly, got a bit better as the week goes on. It's rather odd having the sore throat feeling on the side rather than at the back! In theory, my windpipe is just outside the beam; perhaps I was lying wrong for a couple of days and the edge of it caught a dose. Still, something else to be thankful for.

I've realised that taking photos at the beginning of the week doesn't give a particularly good understanding of what's happening, because that's the moment when the side effects are least, because things get better over the weekend. I should really be taking them on Friday afternoon. Oh, well. I've started this way so I'll finish.

Start of Week 5

This set was taken after my first treatment of the week; so you can see a bigger difference than you might expect between these photos and the previous ones. Almost all the hair in the treatment area has fallen out; what's left is short and has been turned blonde by the process. The back of my ears are starting to go very red; it's places like that, where the skin folds, where cracking happens first.

The uneven coverage you can see on the front is due to the plastic mask; the skin tends to get redder in places where the mask has not been cut away, because the mask slows the beam down, causing more of the radiation to affect the skin. Or so I'm told.

Start of Week 6

This is me this morning, before I went for the first of my last five treatments.

If you look carefully on the front, you can see an inward jag of about 3mm in the vertical red line down the middle of my neck. That's actually representative of the actual shape of the aperture; they put in an extra slice of lead shielding there to try and reduce the dose my windpipe gets. As you can also see, it's not square at the bottom left (as you look at it) corner; again, they put in shielding there to try and avoid irradiating the top of my lung too much.

The lighting's not brilliant, but you can just about see that the treatment area comes up on my jawline. Again, perhaps because of the shield, the edge of that area along my jaw is redder than the part immediately inside it.

More of the hair seems to have fallen out adjacent to the treatment site, leaving a white border - I'm not sure why that is. Maybe it's getting a partial dose due to beam diffraction - enough to kill the hair over time, but not enough to turn the skin red.

The general condition of my skin has started to go downhill; the nurses tell me to expect it to break down and crack this week, behind the ear or in the crease in my neck, or both. The effects continue for a few weeks after the treatment itself ends (this coming Friday) so I'll keep posting pictures to document that.

I'm still not suffering from any tiredness or nausea, praise God, and the sore throat hasn't returned.

And we know that in all things God works for the good of those who love him, who have been called according to his purpose. -- Romans 8:28

Afterwards

Start of Week 7

These were taken this morning, the first day I didn't have treatment, if you see what I mean. On about Thursday last week, the skin started to break down and the top layer began to come off in the areas most affected. You can see the red raw areas clearly on the shoulderblade.

Before this point, it didn't really hurt - now, in the areas where my skin's nerves haven't been severed by previous operations, it is getting rather sore. I've been given hydrogel to put on, plus I'm continuing to use aqueous cream (I switched from E45 at a nurse's recommendation about a week ago) on the unbroken areas. On top of that, I have "Geliperm" hydrating sheets, then a pad to hold them in place and a bandage or silk scarf tied on top of all of that.

The marks where the shell was not cut away - the deeper red lines - are becoming very obvious on the front. (The back is uniform because the shell only covered the front.) I was allowed to take the shell home as a souvenir.

Start of Week 8

I've made really good progress this week. Up until my appointment on Thursday, I was still wearing the Geliperm and so on, but then they changed it for something lighter. Most of the top layer of skin has peeled off on the top of the shoulder, but what's left is in good shape and the redness is fading fast. It's going to be a little while before the hair grows back, though.

People keep asking me when I'll know whether all this trouble and inconvenience did any good - the answer to which, of course, is 'not until the Second Coming'. If the cancer doesn't come back in that area, well it might not have anyway. And if it does, well it might have come back earlier without the treatment. Or it might not. It's impossible for us to tell. I might be tempted to despair, if I didn't know that a loving, ruling God who cares about me personally was watching over the whole thing...