Radiation

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Today (May 19) I have an appointment with the radiation doctor at the LUMC. I am afraid. Not so much against the conversation but what awaits me during radiation therapy. The pulmonologist has indicated that it will be about 15 to 20 radiation sessions  and that I will get pain with swallowing because my esophagus will also be irradiated. Not really something I'm looking forward to.
During the conversation with the radiation doctor, he explains the entire process. They removed the tumor by a minimum margin of up to 2 mm of clean tissue all around. Preferably they have 10 mm of clean tissue, but that was not possible given the location. Because the margin is so small, they want to give radiation therapy as a precaution.

During radiation, all tissue is damaged, good and bad cells. A good cell takes about 6 hours to recover, a bad cell much longer. By every day radiation, the bad cells have no time to recover and will eventually die. The number of radiations is estimated to be somewhat low by the pulmonologist. There will be a total of 30, the number is higher because they have to administer a lower dose because of the vulnerability of the area in which they do the radiation.

A number of organs will be affected by the radiation. The thyroid gland lies in front of the trachea and will therefore receive the same amount of radiation. There is a good chance that the thyroid gland will slow down in the medium term (months to year after radiation). This is fairly easy to remedy with medication.
A kind of web formation can develop in the trachea. This is something that can happen in the longer term. The web formation will make breathing more difficult. The pulmonologist can laser this away through a bronchoscopy.
Scar tissue can form in the esophagus, which can constrict the esophagus and causes trouble to swallow. They can stretch this constriction and the symptoms will pass. This is also something that can arise in the long term.
During the radiation, with a delay of about 2 to 3 weeks, complaints can arise on the skin and the esophagus. The red and sore skin can be treated with a special cream. The esophagus will cause pain when swallowing. During the radiation I will have contact with a dietician who can indicate where I have to adjust my diet.

Given the location of the area to be radiated, it is of great importance that each radiation be in the same position and that it be stationary during the radiation. To guarantee this, a mask will be made with which my head is fixed on the table.

The usual technique of radiation is via photons. It is also possible to radiate with protons in the Netherlands for a year and a half. This technique is much more accurate. To qualify for this there must be a substantial, demonstrable benefit. Due to the vulnerability of the area to be radiated, a calculation will also be made for the proton radiation. The two calculations will be compared and I will be eligible for this with a demonstrable advantage.

It is a lot of information that comes over me. After the conversation with the doctor, an IV is placed and they pick me up for a mask and a CT scan.

Photons vs. protons

Once at home I would like to know exactly what the difference is between photons and proton radiation. There are three proton centers in the Netherlands: in Delft, Groningen and Maastricht. The proton center in Delft is a collaboration between LUMC, TU Delft and Erasmus MC.
The UMCG has a nice explanation about the difference on its website:

"With radiation with photons, the intensity of the radiation decreases, when entering the body. Deeper tissue therefore receives a lower dose of radiation. With photon radiation, complex radiation techniques are often used to radiate the tumor and thus the healthy tissues save as much as possible.
With radiation with protons, most radiation is only released when it reaches a certain depth in the body. By carefully controlling this, it can be delivered to the location of the tumor in the body. "UMCG

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