The major difference with tomo is that a CT scan is taken each day just before the radiation treatment starts and compared (by the system's computer) with the original simulation scan -- the computer then adjusts the IMRT radiation delivery to account for any changes in the location of the tumor(s) due to, say, weight loss, edema, or just normal day-to-day variation. Dr. Lee (our radiation oncologst at Hopkins) says that the device also allows the beams to be directed from more directions and he says it improves such things as sparing of the parotid gland (my notes have him saying that using regular IMRT he finds xerostomia reduced 50% over older EBR technologies and with Tomo, 66%. He uses amiphostine whenever possible, for further improvement). Since I have some rather significant upper end hearing loss, he wants to give me the Tomo as it will also allow him to avoid radiating my inner ears. (I will not be getting cisplatin for same reason).

Anyway, in again Monday for the simulation and meeting with the radiation nurse and more of the staff. A marathon session yesterday (7 am to 4 pm) so feeling both exhausted and somewhat encouraged. The Hopkins staff definitely are cognizant of patient's concerns re treatment and after-effects.

Lots of work being done there on HPV-related HNC (what they think I have) -- they took blood and tissue for testing. Survival rates for non-smoking patients appear to be better than the usual published results -- more like 2/3 after 5 years (their in-house data). They said it will help that I am (other than the cancer!) very healthy -- Dr. Forastiere said I was a perfect weight now BUT -- I should try to pack on some pounds before I start the chemoradiation as I will probably drop quite a bit of weight during the marathon.

A friend who heard about this sent me a huge cheescake -- should be good for about 10 pounds of bulking up!

Barry Cooper

DX 6/21/05, SCC, right tonsil and 1 cm base of tongue, T3N2bM0, Stage IV, tonsillectomy w/ negative margins except at b.o.t., no further treatment -- yet.