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Topic: number of radiation treatments? 28 vs. 33?

Forum: Radiation Therapy - Before, During and After — What to expect from treatment and ways to cope with side effects.

Posted on: Jun 1, 2011 05:56AM

MaxineO wrote:

Hi all, I am almost done with chemo and heading into radiation.  I have visited two radiation oncologists, and while most of there recommendations were the same, one recommended 28 treatments and the other 33.

I have been exploring the site but can't find an answer to why the difference. Does it have to do with stage or lymph node involvement or something else? 

Also, searching through the boards, there are a lot of mentions of boosts. What are these? My doctors never mentioned them.

I appreciate all of your help...radiation is the next stop on the treatment train...

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Jun 1, 2011 06:04AM voraciousreader wrote:

Ask them what the total amount of the rads are.  And also ask if there are any boosts and if so why.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jun 1, 2011 06:06AM voraciousreader wrote:

Boosts are usually given around the surgical site to reduce the chance of recurrence in that area.  They usually give them when the margins are less than 5mm. 

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jun 1, 2011 06:13AM MamaV wrote:

Maxine - I have 6 weekly Taxols to go (5 after tomorrow - finally can count down on one hand) - and will be starting radiation after that.  Im interested in learning more about the radiation too so will lurking here to see what kind of feedback you get.  My RO said to expect 6 weeks of radiation so sounds close to what you are hearing.  Good luck!

By the way, what was your chemo schedule?  You were diagnosed just a few weeks before me and if you are just finishing up, I bet we were on similar schedules.  I was 4 x A/C every three weeks and now weekly Taxol.  Can't wait to be done!

Chemo Started 1/26/2011: 4x A/C Done! 12 Taxol done! 36 Rads done! Took of the wig for good on 12/9/2011 (5 months PFC)! 1 and 4 months year PFC and hair is long enough for an updo (only to hide all the crazy layers) - still not cutting it! Dx 12/17/2010, IDC, 1cm, Stage I, Grade 2, 0/7 nodes, ER+/PR+, HER2- Hormonal Therapy 07/28/2011 Arimidex (chemical name: anastrozole, class: aromatase inhibitor) Surgery 12/29/2010 Lumpectomy in one or both breasts: Lumpectomy in my right breast; Lymph node removal (also called dissection): Sentinel lymph node removal (also called dissection) , Lymph node removal (also called dissection) on my right side Radiation Therapy 07/28/2011 Chemotherapy 01/25/2011 AC + T (Taxol): Adriamycin and Cytoxan, plus Taxol
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Jun 1, 2011 06:20AM , edited Jun 1, 2011 06:23AM by voraciousreader

What Is a Radiation Boost For Breast Cancer?

    By                       Pam Stephan    ,         About.com Guide             

Updated May 17, 2010

             

Question: What Is a Radiation Boost For Breast Cancer?

Early-stage breast cancer is often treated with a lumpectomy or mastectomy and radiation.  Even though the tumor may have been small and no metastasis was found, women and their doctors still look for ways to prevent a recurrence.  The technique of giving a radiation boost at the end of treatment has been very effective in keeping breast cancer from coming back.

Answer:

A Little Extra At The End of Radiation

A radiation boost is one or more extra treatments, given at a higher dose than routine treatments, and targeted at the tumor bed.  This extra dose covers a small area and affects the tissue where cancer is most likely to return.  Radiation boost treatments are given after the regular sessions of radiation are complete.  Women who are 40 years old or younger at time of treatment get the most benefit from a radiation boost, but patients of all ages will have a lower risk of recurrence if they receive a booster treatment.

The Boost Dose Benefits Patients with Early Stage Breast Cancer

For patients diagnosed with early stage breast cancer, either ductal carcinoma in situ (DCIS) or invasive breast cancer, a radiation boost protects against recurrence.  Most patients who have a lumpectomy will qualify for radiation with a boost, and in some rare cases, mastectomy patients may also have radiation and the boost.  There is some disagreement among radiation oncologists as to whether or not a radiation boost really benefits a patient diagnosed with DCIS, but it has become the standard of care.

Having a Radiation Boost

Breast cancer patients may have whole breast radiation (WBI) or partial breast radiation (given with external beams or brachytherapy), after which boost doses are given.  If you're having a lumpectomy and are planning on radiation, surgical clips may be placed at the time of surgery, to help your radiation oncology team target your tumor bed during treatment.  Your boost dose may be given with external radiation, via interstitial catheters, or from within a brachytherapy applicator.  The targeted boost dose may be given in one session, or during five to seven daily sessions. Because the dose is greater than a standard treatment and very focused on a small area of tissue, some radiation fibrosis can occur at the boost site.  In most cases, this should not be bothersome.

Radiation Boost May Mean Fewer Mastectomies, Longer Life

After being diagnosed with breast cancer, the first decision you may face is whether to have a lumpectomy or a mastectomy.  You have to weigh that decision with the fact that breast cancer is most likely to recur in the same breast, right at the tumor site.  Many women opt to remove the whole breast, in hopes of never having breast cancer come back.  A radiation boost is designed to prevent recurrence at the tumor site, even after a lumpectomy.  Research has shown that women who had a radiation boost had fewer local recurrences, as compared to those patients who didn't have the boost. Doctors hope that, because of better radiation techniques, more women will be able to choose lumpectomy over a mastectomy, and have a better quality of life after treatment.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jun 1, 2011 06:24AM voraciousreader wrote:

How Much Radiation?

Page last modified on: July 16, 2008

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The amount of radiation you receive to the breast area depends on factors such as:

  • the size of the cancer
  • the surgical margins of resection
  • the "personality" of the cancer
  • whether lymph nodes were involved
  • the type of surgery you had

Your doctor will prescribe a total dose of radiation. The total dose is broken up into daily doses, which are also called fractions. The basic unit of radiation is called a rad or centiGray. Generally, you will receive 180-200 rads or centiGrays during each daily session:

  • For radiation to the whole breast and/or lymph node areas, the usual total dose is about 4500-5000 centiGrays over 5 weeks. Your doctor may then recommend an additional 1000-2000 centiGrays over 1 week delivered as a boost, targeted to the area where the tumor used to be.
  • Partial-breast radiation with external beam or internal radiation usually involves a total dose of 3400 centiGrays given over 1 week.
 



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Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jun 1, 2011 06:29AM Sherryc wrote:

You really should ask the Drs. but I suspect that 28 is the regular and 33 is with 5 boost.  I had 28 reg and 6 boost for a total of 34 treatments.  My RO did not tell me about boost either he just said 34 treatments.  By the time I started radiation I had heard about boost and asked the techs about it and they gave me the breakdown

Sherry--lump left breast 9/30/10. No chemo, Zometa-6tx over 3 years.Oncotype score 23 with 14% recurrence rate. 34 rads. No family history, BRCA neg. 48 years old @ diagn. BMX/TE 3/26/2012, Exchange surgery 8/21/12, Revision surgery 11/27/12 Dx 9/27/2010, IDC, Left, 1cm, Stage IB, Grade 1, 0/3 nodes, ER+/PR+, HER2- (FISH) Hormonal Therapy 02/06/2011 Surgery 05/11/1997 Lumpectomy in one or both breasts: Lumpectomy in my left breast Surgery 09/29/2010 Lumpectomy in one or both breasts: Lumpectomy in my left breast; Lymph node removal (also called dissection): Sentinel lymph node removal (also called dissection) , Lymph node removal (also called dissection) on my left side Surgery 11/02/2011 Lumpectomy in one or both breasts: Lumpectomy in my right breast Surgery 03/25/2012 Mastectomy of one or both breasts: Mastectomy of my left breast, Mastectomy of my right breast; Reconstruction of my left breast: Tissue expander placement; Reconstruction of my right breast: Tissue expander placement Surgery 08/20/2012 Reconstruction of my left breast; Reconstruction of my right breast Surgery 11/26/2012 Reconstruction of my left breast; Reconstruction of my right breast Radiation Therapy 12/02/2010
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Jun 1, 2011 06:31AM Makratz wrote:

I had 28 reg and 5 boosts with a total of 33.  Ask  your doctors!  Best of luck!

Linda...♥♥♥ Never, never, never give up ~ Winston Churchill
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Jun 1, 2011 09:45AM MaxineO wrote:

This is very helpful. I was told radiation is a given with 4+ nodes positive even though I had a MX.  I wonder if the boosts are given for MX patients?

voraciousreader: thanks for all the information. Figuring out the rads treatments is more complicated than I thought. I had MX but am under 40, had positive nodes but clear margins. So much to consider...

MamaV: I had 4 DD A/C and am halfway through 4 DD taxol (#7 of 8 tomorrow!); treatments every 2 weeks. After diagnosis, I transferred my treatment to Chicago, which delayed surgery to Feb. I started chemo in March and will start rads in July.

Dx 12/1/2010, IDC, 1cm, Stage IIIA, Grade 1, 4/13 nodes, ER+/PR+, HER2-
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Jun 1, 2011 09:59AM MamaV wrote:

Maxine - good luck finishing Taxol soon.  I will be done July 7 and then radiation to follow.

To everyone who finished radiation - this is my new source of major anxiety.  I am worried about the fatigue.  I have taken off a lot of work since December and it has taken a financial toll on us.  I've heard some people say they worked straight through radiation and others say they had to go on disability b/c they were so exhausted!  I can't imagine it could be nearly as taxing as chemo, but this darn breast cancer takes such an emotional toll that I can't get the fear out of my head.  Any encouragement would be appreciated!

Vicky

Chemo Started 1/26/2011: 4x A/C Done! 12 Taxol done! 36 Rads done! Took of the wig for good on 12/9/2011 (5 months PFC)! 1 and 4 months year PFC and hair is long enough for an updo (only to hide all the crazy layers) - still not cutting it! Dx 12/17/2010, IDC, 1cm, Stage I, Grade 2, 0/7 nodes, ER+/PR+, HER2- Hormonal Therapy 07/28/2011 Arimidex (chemical name: anastrozole, class: aromatase inhibitor) Surgery 12/29/2010 Lumpectomy in one or both breasts: Lumpectomy in my right breast; Lymph node removal (also called dissection): Sentinel lymph node removal (also called dissection) , Lymph node removal (also called dissection) on my right side Radiation Therapy 07/28/2011 Chemotherapy 01/25/2011 AC + T (Taxol): Adriamycin and Cytoxan, plus Taxol
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Jun 1, 2011 11:25AM peggy_j wrote:

Vicky, I've heard that  women who had chemo consider radiation to be much easier. (I got to skip chemo. In my case, the fatigue set in half way through rads. I finished 2 weeks ago and my energy is much better now.) The best advice I got was to schedule naps (and go to bed early). Also, exercise helps. I aimed to walk 1/2 hr a day (though sometimes I only made it for 20 mins). I also went to a "guided imagery" class throughout my treatment. The days I went I got the best sleep ever. So maybe try something like that (available on CD) My cancer buddy (at the support center) worked through rads (and she rode her bike to/from treatment!). So like everything, I think this varies for each patient.

Dx 2/2011, IDC, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Jun 2, 2011 11:58AM edwards750 wrote:

MamaV - I work as a supplemental employee and I worked until my first of two surgeries were scheduled. I am allowed 3 months of inactivity from my job. My job is 70 miles round trip from my house and it was a night job. It paid well but once you factored in cost of gasoline, etc., it was not that drastic a drop in family income. I just had my 10th of 33 scheduled treatments and am nowing feeling a little of the fatigue. To be fair I need to work on not operating like business as usual doing everything, because it isnt. The advice you have received is the same I was told by the nurses. Listen to your body when you are tired. Sometimes it isnt feasible to take forty winks but rest when you can. My ONC already prepared me that chronic fatigue would be difficult to deal with and begin to be felt about halfway through the treatments. And by the way I didnt have chemo either but from what people have said who have done both said radiation is a breeze compared to chemo. You will be fine. Diane

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Jun 2, 2011 12:45PM , edited Jun 2, 2011 12:46PM by marjie

I agree - ask your RO.  I had 25 regular zaps plus 8 boosts making 33 total treatments.

Treatment: Rt Lump/SNB Aug 2010, FECx3/Tx3, radsx25+8, Herceptin x18 Dx 7/13/2010, IDC, 4cm, Stage IIA, Grade 3, 0/2 nodes, ER-/PR-, HER2+
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Jun 2, 2011 05:34PM MamaV wrote:

Thanks all!  I had my 7th Taxol today and met with my OC.  I finish chemo July 7 so probably won't start rads until August.  Sounds like rads are doable and I will schedule them in the afternoon so I can go home and rest if I need to.  Right now I will focus on getting through the next 5 weeks of Taxol - one day at a time!

Chemo Started 1/26/2011: 4x A/C Done! 12 Taxol done! 36 Rads done! Took of the wig for good on 12/9/2011 (5 months PFC)! 1 and 4 months year PFC and hair is long enough for an updo (only to hide all the crazy layers) - still not cutting it! Dx 12/17/2010, IDC, 1cm, Stage I, Grade 2, 0/7 nodes, ER+/PR+, HER2- Hormonal Therapy 07/28/2011 Arimidex (chemical name: anastrozole, class: aromatase inhibitor) Surgery 12/29/2010 Lumpectomy in one or both breasts: Lumpectomy in my right breast; Lymph node removal (also called dissection): Sentinel lymph node removal (also called dissection) , Lymph node removal (also called dissection) on my right side Radiation Therapy 07/28/2011 Chemotherapy 01/25/2011 AC + T (Taxol): Adriamycin and Cytoxan, plus Taxol
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Jun 13, 2011 04:58PM , edited Jun 13, 2011 05:01PM by MaggieMc2

Maxine, you got a lot of good information here. I am almost finished with radiation. Just 5 more boosts. It was soooo much easier than chemo. I never had fatigue (had that during chemo), but everyone's treatment is just a bit different. The worst thing for me about radiation is redness, like a bad sunburn, and itchiness. Go to the June radiation boards to get a better idea of what to expect. There is a lot of support here to help you get through every step of this journey.

I wanted to add that I also had BMX and did not have any positive nodes.
Dx 10/19/2010, ILC, Grade 2