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Missing radiation treatments and increased recurrence of cancer.

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I had my first 4 treatments last week, then the machine broke. I had no treatment on Friday or Monday. So 4 treatments and then 4 days no treatment. I was reading a few statistics regarding missing treatments, and according to some data, missing even 1 treatment increases the risk of recurrence. My concern is after only 4 days, then 4 days off, the cancer cells can repair themselves so those 4 treatments might be completely negated. Anyone have radiation, miss a few sessions, and have a recurrence? I am very worried because my cancer was extra-nodal. My radiologist oncologist isn't worried says they do this all the time. But people have recurrences, all the time. I want him to redo those 4 treatments, he won't. I feel my risk of recurrence just went up almost 10%.

Comments

  • gb2115
    gb2115 Member Posts: 553
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    As long as you are completing your total # of treatments, they're not going to give you extra treatments no matter what. I think radiation pretty much puts us at our lifetime radiation limit for the treated area, so it would not be safe. They don't even want you to get sun exposure on the area later.

    I did radiation over the holidays, plus had a broken machine once, so I think I had multiple 4 treatment weeks since the centers are closed on major holidays. Although standard practice, it did used to bug me from time to time. But I have since realized I have zero control over this, so I try to not dwell on it!

  • carmstr835
    carmstr835 Member Posts: 147
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    Thanks for replying gb2115. The sun exposure is for skin cancer, not this type of radiation however both types of radiation, ultraviolet and this therapeutic radiation, do have an increased occurrence of skin cancer as a SE. You are correct in saying here are limits our bodies can withstand and the reason I am so concerned. I was just 4 treatments in and was hoping for a restart, but I really didn't expect him to agree. I know we have zero control over our treatment regarding this, but perhaps we can remember this and help others. I know if I knew this, I would have made sure I went to a facility with 2 machines, in case one breaks. I was under the impression there were 2, but it didn't dawn on me treatment interruptions have such dire consequences. I do now. So if anyone out there is planning radiation, ask what happens if the machine breaks. I was told plan B; but that plan wasn't developed yet. So for me, no plan B. What if it breaks again? I just miss my treatment again. So far, I have had 4 treatments, then 4 days off, and now 4 treatments and 2 days off. The data has been developed for treatment to be 5 days and 2 days off. Anything less is jeopardizing the outcome. I believe my chances are less now than they would have been if I got the treatments as expected and prescribed. I also would not opt to be treated during a holiday. We get 1 chance at this, there are no do overs. If it doesn't work, we fight it for life and if I can lower the chances of that happening, that is my goal. as well as everyone's here, I am sure.

  • gb2115
    gb2115 Member Posts: 553
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    Had I opted to not be treated over the holidays, I would have been past the optimal window of time between surgery and starting radiation. So either option was problematic.

  • carmstr835
    carmstr835 Member Posts: 147
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    Well, machine is broken again. So far, 4 treatments, 4 days off, 4 treatments and 3 days off, maybe 4.... still no new time for this missed one. I have research that claims missed radiation, even if eventually completed increases the risk of recurrence. Why do radiology oncologists refuse to believe this data? Some Oncologists believe the 2 days off are not needed, that it would be a better outcome with zero days break in treatment.

  • castigame
    castigame Member Posts: 336
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    Carmstr,

    Too frequent machine breakdown is not acceptable period. Is it possible to change rad place?

  • illimae
    illimae Member Posts: 5,657
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    carmtsr835, I missed two sessions due to Hurricane Harvey after the weekend, so I missed Saturday-Tuesday. When they had enough staff to open on Wednesday, they were pretty insistent that I come in, which I did. I've read the same study info and I am not overly concerned for the following reasons.

    1. The missed two days was right in the edge of my RO's comfort level and I think protocols err on the side of caution.

    2. The study made a point of saying that the reason could very well be that those "non-compliant" in radiation could be non compliant in other ways like maybe missing chemo, taking unapproved medications, not making suggested diet/lifestyle improvements, etc.

    I understand the concern but hopefully you can focus on the other things within your control to better your odds.

  • carmstr835
    carmstr835 Member Posts: 147
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    They fixed it and will do my treatment tonight. They are trying, working nights for us, I appreiate that!

  • Racy
    Racy Member Posts: 974
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    When I had radiation six years ago, the centre had a scheduled day each month when the machines were off line for planned maintenance and no treatments were given. I missed two days due to this. I think I also missed a day due to a public holiday.

    I don't believe the centre would have done this if it was thought it could jeopardise the effectiveness of treatment.

    Hopefully, you are able to have an open conversation with your RO about this and your concern can be allayed.

  • TWills
    TWills Member Posts: 509
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    carmstr835, could you link the statistics and data that you spoke of. Especially the "dire consequence" part of it. I've seen one study quoted on several articles but other factors were included. My RO added 5 treatments to my plan because after 3 weeks of rads I had to stop for 4 weeks because of an infection, which I had surgery for, and then the hurricane. I've started back now and he told me today that he was adding 5 treatments, that will be 40 total treatments, some of those will be boosts. I have no doubt that treatments should be completed as planned however, I'm not sure there has been enough study on it to put a percentage on reoccurrence rates. Its definetly unsettling.

  • carmstr835
    carmstr835 Member Posts: 147
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    Here is the research I have compiled. Sorry I don't have the time to sort through it but it is pretty clear delays are not acceptable and should be avoided.


    The effect of treatment interruptions in the postoperative irradiation of breast cancer.

    https://www.ncbi.nlm.nih.gov/pubmed/16127290\

    Treatment Interruptions or Delays with Radiation

    http://cancergrace.org/radiation/2008/07/28/rt-del...

    Biological response of cancer cells to radiation treatment

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC44296...

    Repopulation of cancer cells during therapy: an important cause of treatment failure

    http://www.nature.com/nrc/journal/v5/n7/full/nrc16...

    Perez and Brady's Principles and Practice of Radiation Oncology

    https://books.google.com/books?id=NyeE6-aKnSYC&pg=...

    Radiobiology: Time dose fractionation

    http://www.thegreenjournal.com/article/S0167-8140(10)80090-8/fulltext

    Compensability index for compensation radiotherapy after treatment interruptions

    https://ro-journal.biomedcentral.com/articles/10.1...

    The timely delivery of radical radiotherapy: standards and guidelines for the managment of unscheduled treatment interuptions 2008

    http://www.sascro.co.za/downloads/BFCO_RT_Interrup...

  • TWills
    TWills Member Posts: 509
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    Some of these articles seem to be duplicated and are quite general including different types of cancer and diagnosis. Interpretations and general opinions can be very scary to read and should not replace actual reasearch with supporting data. You can drive yourself crazy with that. I'll tell you what both my MO and RO told me at my appts this week when I asked about my interruption in radiation and my chemo having to be reduced. They both had basically the same answer although they explained it in opposite ways. I asked my MO what my likelyhood of reoccurance #'s would be now that I've had several issues with treatment, delayed port placement so chemo started late, both of my chemo drugs had to be lowered by 20% because I was very neutropenic, I missed a chemo treatment because of that as well, had to stop one chemo short of finishing because of neuropathy, delayed radiation by a few weeks to have my expanders put in, I had a 4 week interruption in rads after 3 weeks because of an infection and having one expander removed and the hurricane also delayed another several days because of no power. Believe me, I'm my mind my reoccurance numbers have went up. My MO said that she would not change my numbers because research and statistics include both uninterrupted, interrupted, and modifications in treatment plans. She said rarely does a plan go perfectly so they don't plan for it to #'s wise. My RO answered the question from a different direction but it was basically the same answer. He said there is no exact research that's studied only missed or varied treatment plans so there is no comparing.He did add several treatments to my plan only because my break was so long but he said he was more than comfortable and confident with either plan.

    I hope the rest of your treatment goes smooth, it stinks going through everything we go through let alone not feel confident in the treatment or outcome.

  • carmstr835
    carmstr835 Member Posts: 147
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    There had not been a study done purposely interrupting the plan of treatment. My concern is, there Is reason for a plan and when not followed the outcome is compromised. So I believe there should be an alternative plan for radiation machine breakdowns. One of my articles suggests that your simulation be mapped on 2 machines incase of breakdowns. Malfunction seems to be the largest reasonfor interrupting the treatment. My hospital has suddenly hired a lot more radiation techs so hopefully they are buying a new machine. The data is in those articles if you want to really read between the lines. My radiologist also claims no issues regarding missing 4 in a row. I believe there is rejuvanation to the cancer cells when the treatment plan is broken. Believe what you will. I am hoping for change. It is not for me, but for those after me. And those still deciding where to have their radiation and choosing a place with a backup plan incase of breakdowns

  • carmstr835
    carmstr835 Member Posts: 147
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    Almost 5 years to the day, my cancer is back. I had radiation to sternum, collar bone, right chest and right under arm. My cancer returned to bothlungs. I wonder if all my missed days of radiation has anything to do with this reoccurrence

  • parakeetsrule
    parakeetsrule Member Posts: 605
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    I did every single radiation treatment and mine still came back in my chest nodes, lung pleura, and bones. So missing treatments probably didn't have an effect. Regardless, it's in the past. Let it be and don't dwell on it because it doesn't matter now. Don't go down that rabbit hole because there's nothing good down there. Focus on today and the future.

  • carmstr835
    carmstr835 Member Posts: 147
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    Yes Parakeetsrule, you are right. What is done is done.

    There are many things in my treatment that could have increased my chances for reoccurrence other than the missed days in radiation. I actually believe my cancer could have been spread at the needle core biopsy. I was terrified of the needle core biopsies and wanted an excisional biopsy, but could not find a surgeon that would break protocol. It could also have spread because my chemo did not start until 6 weeks after my DMX. Or it could be because my radiation did not begin until 7 months after my bilateral needle core biopsies of 11 needle cores from 2 very small tumors, neither was more than 10mm. But 9 days after those biopsies, the cancer grew in my lymph nodes to 2.6 cm and burst. It was called extra nodal. Surgery wasn’t until 1 month later. Radiation was 6 months after DMX. There have been studies that radiation needs to be within a certain time period, and sooner the better. 6 months is definitely an issue with less positive results.

    My oncologist believes it returned because I refused endocrine therapy, so he blames me. Blame does nothing to help, but research and careful adherence to the best outcome protocols. All water under the bridge for me though, you are right.