The proton beam
The final phase of breast cancer treatment (if you don't count reconstruction surgery) is radiation. The standard radiation protocol uses IMRT where radiation targets residual cancer (or areas where your tumor was) and any lymph nodes that couldn't be reached during surgery. The issue with IMRT is that it also radiates surrounding tissue and since the breasts are above the lungs and near the heart, you can develop scar tissue in these organs. Additionally, the radiation can damage the skin causing more infections and can potentially make reconstruction difficult. The other alternative is Proton Beam Therapy which is also radiation but uses a pencil beam that specifically targets areas where there was cancer and positive lymph nodes but only targets those exact areas as the beam can be programmed to stop at certain depths (meaning no damage to surrounding organs). A film is applied to the skin for the entire duration of treatment to prevent the flora and fauna from mutating and causing skin damage. The downfall to Proton Beam is that it is only available in 27 location in the country and the pencil beam is only available at Mayo Clinc. If you are lucky enough to be at a facility that provides the beam, getting your insurance to approve can be a nightmare. In my case, proton beam was recommended because of my age and because I had lymph involvement near my sternum (right next to the apex of my heart) and one under my clavicle. Surgery is not recommended for these areas. To avoid difficulties with insurance Mayo charges the same for IMRT as Proton Beam ($195,000 for 25 treatments), however my insurance denied my treatment. We appealed the case and after a stressful three weeks we received approval the day of my treatment.
The beam is moved by a machine that is three stories tall and is moved by magnetics that accelerate it to 2/3rd's the speed of light. To prep for the beam, I had to get four tattoos on my body which all line up to lasers to ensure that I am positioned correctly. A mask and headrest was made that locks me into position for each treatment and my legs are clamped down to avoid any movement. I share a beam with four people who are all in different chambers - the beam bounces back and forth between each chamber and beams me three times over the course of about 30 minutes. The treatments are at night (around 10PM) as there are children that need to be sedated in the the morning, so they push the adults to the evenings when possible. As my treatment progresses I will move into day time appointments. I finished 14 treatments as of Friday another 11 to go...so far no issues except a bit of skin itching and logistical issues as I need to be in Rochester, MN everyday
. The radiation nurses claim that the patients who have experience chemo, don't typically notice the side effects of radiation, but if you haven't been through chemo then radiation can be challenging.