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Topic: Is IMRT used routinely in highly ranked cancer centres?

Forum: Radiation Therapy - Before, During, and After —

What to expect from treatment and ways to cope with side effects.

Posted on: Nov 22, 2019 10:03AM

Brooklyn1234 wrote:

Hi,

I'm facing radiation of my mastectomy site/chest wall after a recurrence. At my cancer centre they don't do IMRT routinely for breast cancer, but my tumour is very near to my heart and I want to explore this option before giving up on it. It's possible I could go to another hospital. My radiation oncologist said they get good enough results without use of IMRT, but for those who are being treated at places like Sloan Kettering, MD Anderson, Mayo Clinic etc, I would love to know what your experience has been. Thank you!

Dx 11/1/2009, 1cm, Stage I, 0/9 nodes, ER-/PR+, HER2+ Dx 9/2019, IDC, Left, 1cm, ER-, HER2+ Chemotherapy Taxol (paclitaxel)
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Nov 22, 2019 12:32PM ThreeTree wrote:

Hello Brooklyn - I would urge you to look into proton therapy, especially regarding the heart issue, if you can at all. There is a thread about protons a few below this one if you scroll down.

While I was not treated at a place like Mayo or MD Anderson, I have been getting treatment in a major North American (west coast) city that has state of the art cancer treatment and a proton center. I believe IMRT is done here also, but again, with the heart issue, my understanding is that protons are definitely the way to go. I think IMRT is the next best, so to speak, if you cannot manage to get proton therapy.

I can appreciate that you have constraints and might not be able to do some of these things - the system is so unfair! In that case, it is my understanding that things like the breath hold can help to a meaningful degree.

Whatever you eventually do, I wish you all the best and the most successful of treatments.

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Nov 22, 2019 12:37PM Brooklyn1234 wrote:

Thanks for the response! I'm in Canada now, and unfortunately proton therapy is not available.

Dx 11/1/2009, 1cm, Stage I, 0/9 nodes, ER-/PR+, HER2+ Dx 9/2019, IDC, Left, 1cm, ER-, HER2+ Chemotherapy Taxol (paclitaxel)
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Nov 22, 2019 12:48PM ErenTo wrote:

Hi Brooklyn, where in Canada are you? I had IMRT done at Princess Margaret, Toronto. They used IMRT on me because the location was close to the heart and I also did it in breath-hold position.

Survived an unexplained sudden cardiac arrest b/w surgery and chemo (while attending a chemo info session at the hospital). Code blue, CPR, induced coma, ICU, ICD. Escaped alive with heart and brain unscathed! Dx 12/8/2014, IDC, Left, 2cm, Stage IIIA, Grade 3, 6/13 nodes, ER+/PR+, HER2- (FISH) Surgery 1/11/2015 Lumpectomy: Left Chemotherapy 3/19/2015 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Hormonal Therapy 7/23/2015 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Radiation Therapy 8/3/2015 Breast, Lymph nodes
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Nov 22, 2019 12:58PM Brooklyn1234 wrote:

Interesting. I'm supposed to be at PM, but I've already checked with my RO and she said IMRT is not routinely used on breast cancer patients. So in other words I can't have it. I'm looking into Sunnybrook.

Dx 11/1/2009, 1cm, Stage I, 0/9 nodes, ER-/PR+, HER2+ Dx 9/2019, IDC, Left, 1cm, ER-, HER2+ Chemotherapy Taxol (paclitaxel)
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Nov 22, 2019 01:14PM ErenTo wrote:

I didn't know that, but I know it's not standard. It's possible they offered me as it was right after an unexpected cardiac arrest and I have a device implanted not too far from the radiation site, so they didn't want to take the chance.

Survived an unexplained sudden cardiac arrest b/w surgery and chemo (while attending a chemo info session at the hospital). Code blue, CPR, induced coma, ICU, ICD. Escaped alive with heart and brain unscathed! Dx 12/8/2014, IDC, Left, 2cm, Stage IIIA, Grade 3, 6/13 nodes, ER+/PR+, HER2- (FISH) Surgery 1/11/2015 Lumpectomy: Left Chemotherapy 3/19/2015 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Hormonal Therapy 7/23/2015 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Radiation Therapy 8/3/2015 Breast, Lymph nodes
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Nov 22, 2019 01:32PM Brooklyn1234 wrote:

Sorry to hear you had a heart event on top of everything, that must have been terrible. Did you have all your treatment at Princess Margaret? Did you have a good experience overall?

Dx 11/1/2009, 1cm, Stage I, 0/9 nodes, ER-/PR+, HER2+ Dx 9/2019, IDC, Left, 1cm, ER-, HER2+ Chemotherapy Taxol (paclitaxel)
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Nov 22, 2019 08:35PM ThreeTree wrote:

I did a real quick google search and it looks like a year ago they started to work on a proton center in Montreal. I also got some idea that there might be protons available up in BC. A place in Vancouver called "Triumfe". I might have all this wrong, but it might be worth checking more. My sense is that you are in eastern Canada. Is there any way you could get to the US? I think there are a number of centers in the US on the east coast and into the "east midwest" if you will. Would Canadian insurance cover a trip to the US if it was deemed medically necessary? Not looking for real answers for myself to these questions, but just posing some ideas that you might want to consider and that might help. Some of the US centers might offer IMRT, even if they don't do protons, but it sounds like the easiest thing for you to do would be to push for the IMRT at Princess Margaret. Can you get a second opinion from another Canadian doctor? If the other Canadian poster, ErenTo, was able to get the IMRT, it seems like you should be able to also - maybe just have to "yell and scream" a bit?

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Nov 23, 2019 03:16PM Brooklyn1234 wrote:

Thanks so much for your help, ThreeTree. I looked up the Montreal and BC proton centres. Just for any other Canadians who might be reading this, the one in BC is only for eyes, and the one in Montreal is still in the talking stage and would be a private facility anyway (so, probably there would be no difference between going there or to the US). It looks like the various provinces aren't sold on proton yet except for children and eye cancers, and are choosing to send kids to the US for treatment rather than build capacity locally. There are interesting things going on with MRI guided radiation in Toronto, so I might switch my focus to that. On the off chance anyone has done that, I'd love to hear about your experiences.

Dx 11/1/2009, 1cm, Stage I, 0/9 nodes, ER-/PR+, HER2+ Dx 9/2019, IDC, Left, 1cm, ER-, HER2+ Chemotherapy Taxol (paclitaxel)
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Nov 23, 2019 08:17PM ThreeTree wrote:

If you do wind up having to go the traditional route, Brooklyn123, I can tell you what my proton therapy oncologist told me when it looked like I might not be able to find a way to get the protons covered (I eventually did). What she said was that they are still researching protons and that it is not 100% proven that they are better than traditional radiation (photons/x-rays). She said they still do not have the long term data necessary to make that determination. The other thing she said that might be reassuring to you is that traditional radiation has improved greatly over the years and the gap between the benefit of proton over traditional radiation has closed considerably, and it is due to vast improvements in traditional radiation therapy. Apparently with traditional radiation they not only do the breath hold now to protect the heart, but they also just sort of "skim" for lack of a better word, the top of your chest area with radiation from different side angles, rather than just going front to back like so many of the diagrams online show. This apparently helps considerably in preventing heart and lung damage down the road. She also said that the possibility of heart and lung damage is in the low percentages to begin with and that while it may ultimately be lowest with protons, it really isn't all that high with any kind of radiation.

I hope that this is somewhat helpful/reassuring and that you are comfortable and successful in whatever treatment you finally obtain. Good luck!

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Nov 25, 2019 07:14PM Brooklyn1234 wrote:

Thank you -- this is very helpful!

Dx 11/1/2009, 1cm, Stage I, 0/9 nodes, ER-/PR+, HER2+ Dx 9/2019, IDC, Left, 1cm, ER-, HER2+ Chemotherapy Taxol (paclitaxel)

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