“Surprise” in September 30 MRI Results

First off, let me apologize for being so slack with updates.  Honestly, I was waiting for these fall scans before posting anything new.

Back on April 3, I had a CT scan of the chest, abdomen, and pelvis, which looked fine and even showed some slight shrinking of that right perinephric mass (the one treated with radiation in February 2025).  Still, a higher-resolution MRI six months later was going to provide more definitive results. And indeed, I was right!

According to the report, my latest MRI showed “decreased size of metastasis in the right perinephric space,” shrinking from 3.5 × 2.2 cm in November 2024 to 1.8 × 1.8 cm now — about a 50% reduction. Yes!  Oh, and my right pelvic tumor (irradiated in December 2022) remains “stable” too.  Another win!

The Twist

My excitement was short-lived though when I noticed the report also indicated a new metastasis (1.8 cm) in hepatic segment III.  Here’s a screenshot of the intruder:

The radiologist described it as a “new 1.8 cm circumscribed hepatic lesion in segment III, which restricts diffusion and shows heterogeneous enhancement.”  Honestly — and I realize this could just be denial talking — I wasn’t all that impressed with the image.  It didn’t have the same 3D look of the other tumors I’ve dealt with.  This one looked more like a shadow, with no real form at all.

Of course, the radiologist knows far more about this than I do!  Thankfully, my Mayo doctors are already on it and are planning a biopsy.  I’ll reserve final judgment until the biopsy results are in (probably a few weeks).

Processing the “Surprise”

So, that’s my big “surprise.” And while I’m not sure exactly what to make of it yet, I do feel confident that this tumor — like all the others — can be treated, whether surgically or with radiation.

It is true that my current chemo regimen seems to be losing effectiveness (as evidenced by two new tumors since my re-diagnosis in 2019, both in the last year), but maybe it’s at least slowing things down. Even my oncologist thinks I’m incredibly fortunate to be nearly seven years out from a stage 4 diagnosis.

Hopefully, my lucky (or blessed) streak continues and this latest blip doesn’t turn into a trend!

Nutrition is Key to Cancer Recovery!

Before anybody quickly responds to this title with "OK Boomer" or "Thanks Captain Obvious", let me be clear as to what I'm talking about.  In this case, a picture is worth 1000 words:

Yes, just as I did prior to each intensive chemotherapy treatment back in 2008, I was sure to stop at The Varsity for a chili dog, onion rings, and a frosted orange!  I cannot explain scientifically how this combination both kills cancer and leads to healing, but I know from experience that it works.  I'm also sure to not miss my dose of Lipitor that day! 😁

I'm also happy to report that my treatment wrapped up on Friday and we're back home now in Ponte Vedra, Florida.  I'll add this certificate to my collection:

Next follow-up is in about 3 months.  At that time Emory will do a detailed scan and compare that with images captured during the planning phase (back in mid-January).  I fully expect to the tumor to both shrink and show signs of necrosis.

Now time to relax and get ready for what I'm hoping will be an exciting Superbowl tonight!  We'll talk next in May!

It's only Monday but it feels like FryDave!

So I started the 1st of 5 treatments of Proton SBRT today and things went well!  I have to admit, however, that I actually got a little nervous this time.  Why?  In part it's the triple-dosing I'm getting with each round and being worried that I'll move or twitch when the beam is active.  But another part is because the prompts/hints were all different this time as compared to 2 years ago.  Back then I knew exactly when the beam was running as it made an "old school typewriter" noise.  No detectable noise at all this time (though perhaps we had the music going too loud).  And from my angle (laying face up on the table) I could not see any radiation warning light (usually a red flashing light that goes on when the beam is active).  All I got was a one-time "we'll be starting radiation soon" announcement but didn't know when the beam was running.

What I can say is that the radiation plan calls for 3 different beam angles, all coming in from my back side.  This is not surprising as tumor itself is behind my right kidney.  Prior to turning on the beam at each location, I am told that the techs had the doctor look at a live X-Ray of me to verify that I am lined up exactly.  From what they told me when it was over, I was lined up perfectly with each of the 3 beam applications and kept very still the entire time.  I'm happy to hear that as I felt like I was about to have a calf cramp just in anticipation of what was about to happen.

For the remaining treatment days I've requested that the techs give me a "heads-up" just before activating the beam.  This will help me to remain calmer and control my breathing because (in my opinion) knowledge is power.

The guys there in "the purple treatment room" (one of 4 active proton therapy rooms) were really awesome and not only let me take some pictures, but they took this picture of me right after my first treatment.

And no, I wasn't trying to look sexy, I just am!

SBRT Proton Radiation "Approved"!

I'm happy to report that my proton radiation treatment has been "approved" by United Healthcare (UHC) under the following conditions:

1. It must be administered as Stereotactic Body Radiation Therapy (SBRT) -- The key difference between SBRT and "normal" proton therapy is SBRT delivers radiation in higher dosages over a shorter number of cycles (5 cycles in this case).  Both approaches, however, make use of safer proton radiation, which should reduce "radiation splash".
2. It must be administered between January 1 and March 26, 2025 -- obviously this is the easy part!

Though I'm very happy with the approval, I wish to add that Emory indicated that there is no cost difference between SBRT with Protons vs SBRT with X-Rays.  Cost would only go up if proton treatment was administered the "normal" way: lower dosages over a greater number of cycles (e.g., 15 cycles).  This may help explain the quick approval by UHC.

The one concern I have about SBRT is that the higher dosage with each cycle means that delivery must be very precise, otherwise any errors or misalignments are magnified.  This is of particular importance when it comes to my right kidney, which abuts the tumor.

That concern aside, I'm also happy to report that I will be undergoing simulation scanning this Thursday (January 16).  This is when they use CT and MRI scans to carefully map the area being treated.  They will then create some sort of "cast" (likely of my midsection) that they will later use to help get me aligned properly during treatments.  And in addition to the cast, they will put marks on my body to further assist with alignment during treatment.

Next, the radiation doctors use the scans in order to produce a radiation plan.  It can take up to 2 weeks after the simulation scanning for this plan to be complete.  The plan will consist of the precise dose, location of radiation, beam angles, etc.  Treatment cannot start until this plan is completed.

Once treatment starts (probably 2-3 weeks post simulation), I'll get blasted with high dose radiation for 5 consecutive days using pencil beam proton therapy.  Here's a helpful illustration that shows how it works:

Pencil Beam Proton Therapy

This phase of my cancer journey is moving actually much faster than expected, but that's fine with me.  Probably the less time I have to contemplate the "what-ifs", the better!