Respiratory-Gating Used to Treat Carol's Breast Cancer
Carol Keys found out she had Stage I Breast Cancer not long after she and her sister lost their mother to a cancer of unknown primary, which is to say, her doctor’s couldn’t tell where the cancer had begun. Carol, fortunately, had always been diligent about routine check-ups, and when she went in for her annual mammogram in 2007, a lump was found at the back of her chest wall. A biopsy shortly thereafter confirmed that the lump was cancerous. Carol describes the moment she was informed it was breast cancer: “It’s like that cartoon where the dog is listening to his master and they’re hearing ‘Blah blah blah - cookie - blah blah blah.’ I heard “Blah blah blah - cancer - blah blah blah.”
Despite her initial shock, Carol was comforted by her ‘nurse navigator’ at the cancer institute where she was treated, Cindy. Cindy held her hand, walked her through each step, and explained what she could expect in treatment. She introduced surgeons for Carol to meet with and discuss the next step – a lumpectomy. In Carol’s case this was an outpatient procedure, meaning she was able to leave the hospital shortly after the surgery. Study of the cancer cells that were removed indicated that it was non-aggressive and her surgeon recommended radiation therapy.
Her radiation oncologist met with Carol to discuss her radiotherapy treatment plan. The next step was a ‘simulation,’ where her team took image scans of her tumor site, and drew very small tattoos on her body – like freckles – to help with positioning her on the treatment ‘couch.’ “That was exciting,” she laughs, “I wanted my tattoos in pink, but they wouldn’t give it to me…” A body cast was molded especially for Carol, which would allow her arm to relax overhead while the radiation was delivered to the left side of her chest, where the cancer had been.
Carol is also a trained singer, and so when it came time to practice respiratory gating, she viewed it as an opportunity to ‘rehearse.’ Just like practicing breath techniques for singing, she simply had to take a big breath, and hold. Taking a deep breath created a space between the chest wall and the heart and lungs, thus minimizing the exposure to surrounding healthy tissue. Each hold was only few seconds because the radiation is delivered so rapidly.
After a few sessions, Carol found a sense of ease towards radiotherapy. She had it down to a simple routine; she would arrive, change into her gown, and then sit and have a cup of coffee with her new pals who were also in treatment until she was called in. In the treatment room, her team would play her favorite music. “I could talk to [my team] with the microphone. I could say ‘I’m freaking out in here you guys.’ And instantly I would be out of there. Of course, I never did freak out - I didn’t need that. But I knew I could! It was just easy. I was confident going into those sessions everyday.” Although most people experience some side effects with this type of treatment, Carol experienced no major side effects. She went to the gym, worked several hours a day, read a lot, and spent quality time with her friends who surrounded her throughout the treatment experience.
As of September 2012, Carol is three years cancer-free. She is back to once a year mammograms, and she sees a medical oncologist once a year. When you talk to Carol, it’s hard to imagine that she really had to battle breast cancer. Her perspective is so positive. She says “Sometimes gifts come in funny-looking boxes, but if you open the box – however weird the box looks – there’s a gift in there. I can’t even begin to tell you how many emerged.”
Varian would like to thank Francine Halberg, M.D. and the Marin Cancer Institute in Greenbrae, CA for their invaluable assistance in the preparation of this story.