I had my periodic MRI to check on the status of my tumors on the Tuesday between Xmas and New Years. The next day Debbie and I went in at 9AM loaded down with books, papers, magazines, laptops, and Sudoku puzzles, and indeed, we waited until ~2pm to see Dr. Fine. When Dr. Fine did not ask what was new in astrophysics, we knew they had found something new. Indeed, they found a tumor on the surface of my brain above my left optic nerve in the optic chiasm (someone said it really isn't a tumor in my brain but on my brain). Looking back over the previous one or two MRIs they could see the growing tumor as a small spot that was easily mistaken for an artifact. Dr. Fine laid out a number of surgical and radiological options that would be considered after further tests.

A BRAIN TUMOR?!?

The rest of the week was devoted to more tests: a more detailed MRI of the brain, and an opthalmalogic exam to determine whether the tumor is pressing on the optic nerve (it isn't). The opthalmalogic test was clever: to map out my field-of-view I stared at a screen and pressed a button whenever I saw a light flash at different locations. The lights were of different intensities. Using lights that flash on and off randomly, instead of a moving light, overcomes the brain's tendency to extrapolate the motion of objects across dead spots on the retina.

A BRAIN TUMOR?!?

Today we went in to see Dr. Fine and his radiation oncologist. The more detailed MRIs showed that surgical removal of the tumor would probably not be successful at removing the entire tumor (requiring further radiation anyway). Irradiating my entire brain to kill the tumor and anything else that is growing would probably damage my brain, a rather precious part of my anatomy. As I mentioned in my previous circular, protons localize the dosage, but are not used when regular gamma-rays will suffice. Gamma-ray dosage, and thus the damage, can be localized by using multiple beams that converge on the tumor: the dosage is high where the beams converge, and lower elsewhere. From what I understand, using this localization technique in a single large dose is called 'gamma-knife' while 'fractionating' the dose (breaking it into small doses over weeks) is called steriotatic (or stereotatic) radiation therapy (SRT). In my case SRT is by far the obvious option-as the doctors said, 'a no-brainer' (yes, they realized the absurdity of the phrase in this case!). Usually, healthy cells suffer less from fractionated treatment than tumor cells, and small errors in aligning the beam with the tumor average out over many treatments.

SRT is in the repertoire of NIH's radiation group, so I will not have to go out-of-town or to some other facility.

The treatments will be time consuming both for me and for the facility since extra care will go into the planning and the beam alignment. Each treatment might take an hour. However, the side effects should be surprisingly small. I should not go totally bald (in case anyone was wondering whether I would look like Yul Brenner), but there might be some localized hair loss. I might develop some rawness in my throat during the treatment. Over the years there might be pituitary dysfunction.

An interesting additional factor is that the chemo drug I was on for a year and a half seems to amplify the effects of the radiation, so I will be taking low dosages of this drug every night while I am on the radiation (I will probably continue with this drug as a chemo drug afterwards).

So the next week will be taken up with CT scans and MRIs, a visit to my non-NIH oncologist and to a dentist. Dentist? Instead of bolting my head down each time, I will bite down onto a bit that is bolted to the framework surrounding my head. The bit has to be shaped to my teeth, hence the visit to a dentist. The treatments will hopefully start the following week.

Please excuse me if I've spoken to you since the tumor was discovered, and did not mention it. I did not want to say anything until the treatment plan and its likely outcome were clear. The doctors, and therefore we, are sanguine that this treatment will be successful with little or no resulting impairment. There is a realization that more tumors might show up in the brain, and I might have to undergo additional SRT.