Starting Radiation December 2019

Hello

I will have my setup on December 10th and start radiation on December 17th.

I had my setup on the 10th. It took about an hour and was pretty easy. I had my five tattoos and needles stung but nothing serious. I am doing the deep inspiration breathing as radiation on left side. This is supposed to reduce radiation to heart. I asked tech if some of my heart still in range and he said a tiny bit. I’m not sure what tiny means in medical terms but will ask the radio oncologist. I asked if there was anything else I could do to reduce this exposure and he said no. I was feeling a little low after appointment due to info on heart And that I will be only doing five days for two of the five weeks due to Christmas and New Years holidays. I will 1 week of 3 days, 2 weeks of four days, and two weeks of five. The optimal is five days a week and 8-12 weeks after lumpectomy. It will be 13 weeks as I had two sentIntel node biopsies as none were in initial sample and I was awaiting Oncotype results to determine chemo. I went for walk afterwards to try to clear some negatives thoughts and it helped at time, but doubt and discouragement still creeps in at times. I will be happy to get started with rest of December’s

Deweygirl19,
I hope all went well on Monday. It must be surreal to be on the other side.

Neeli,
I hope things are going well for you too.

Spoonie77
Thanks for all tips and advice

I have done 2 sessions so far and will be finished January 16th if all goes well.

thanks ChaClarey, it went well! I work with a great team who I trust, literally, with my life. Very quick and easy. 5 fx down 31 to go!

Hello December’s

Neeli, I hope your skin is doing better.

Deweygirl19, I’m glad it went well.

Cowgirl13, thanks for the check in and advice.

I have 4 down and 16 to go, so far so good. I am using Cavilon barrier film on advice of radiation tech.

michrsm, are you applying lotion immediately after you finish radiation treatment? I applied lotion when I was dressing immediately after radiation. I didn't have the burning feeling starting later like you are - but we all get different side effects.

Redhead: I had left sided radiation to chest wall six years ago. It was optional for me and I really struggled with the decision and researched everything. What I can say, is stats about risks are way out of date. Left sided radiation is similar to right sided radiation for risk factors. Technique is so much better. But it is not risk free. Nor is avoiding radiation. Hate how difficult these decisions are. Have serious discussions with your health team. And then factor in your personality and tolerance for risk and SE’s. A pro con debate is the reality. Wish a best practice was obvious. Hug

Redhead - I am only 5 months after my full breast radiation on the left side. I had lymphvascular invasion, so I felt that having radiation was important. I read a study that said that "breath holding" reduces damage to heart significantly. The first radiation oncologist I went to did not believe that breath holding made a difference. So, went with a different radiation oncologist. I found out towards the end of radiation when I couldn't see the "breath holding box" that was projected on the ceiling after they moved the machine that they actually monitor how well my breath holding is working as they verbally coached me to relax my breath just a tad, etc. I've had PCP, med onc and rad onc all listen to my heart and lungs in the last two months and none of them expressed any concern. I am not aware of any long term negative side effects yet.

I did the 'breath holding' protocol with my radiation. It was really easy. Also wanted to say that after my treatments, as I was changing into my clothes that is the time I would generously apply the aquaphor. I basically wore extra large t-shirts.

Hi all. I just started radiation yesterday (yes, the day after Christmas!). I am getting 30 days on both sides which includes 5 boost treatments. I may be imagining things but my skin already feels itchy and swollen (after only 2 treatments). I used aquaphor right after and calendula cream before bed.

I must admit I struggled with this part of the treatment more than the others (I did chemo, then hormone suppression, then double mastectomy and now radiation). But it has started and now I am eager to get this over with!

Terry

redhead403- I can’t speak for what every doctor does but at my clinic they do deep inspiration breath hold for left sided breasts to reduce dose to the heart. We also do a treatment technique called IMRT (intensity modulated radiotherapy) that allows us to reduce lung and heart dose. This is more expensive and insurance doesn’t like to pay for it but are more willing for left sided breasts. The rad onc I work for gives a larger boost dose for positive margins or close margins. I’m getting more because my margins were close. As for heart dose it really depends on your body habitus (or placement of your organs) each person is different. Some patients hearts are far away from their chest wall. Some patients hearts are right up against the chest wall and even taking in a deep breath doesn’t move the heart away much. My rad onc dr is very specific where he puts the borders to reduce dose to lung and/or heart no matter which breast we are treating. We do so much more now to reduce doseto lung and heart than we did 20 years ago.

That being said there is always a risk of late effects from radiation. You have decide what’s right for you. I hope you have a doctor willing to talk to you about all of your fears.

redhead403, I have copied this article on hypofractionated radiation therapy from our BCO site here.

New Guidelines Say Accelerated Whole-Breast Irradiation Should Be Used to Treat Most Breast Cancers

The American Society for Radiation Oncology (ASTRO) has put out updated guidelines on whole-breast radiation therapy.

The updated guidelines say that most women diagnosed with breast cancer should be treated with accelerated whole-breast irradiation as the standard of care. The new guideline greatly increases the number of women recommended to have accelerated whole-breast irradiation.

The updated guidelines were published online on March 12, 2018 by the journal Practical Radiation Oncology. Read "Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline."

The new guideline replaces the ASTRO guideline released in 2011, which recommended accelerated whole-breast irradiation for selected patients only: mainly women 50 and older when diagnosed and women diagnosed with breast cancer that was small and had not spread to the lymph nodes.

Women diagnosed with early-stage breast cancer who have lumpectomy to remove the cancer usually have radiation therapy after surgery. Radiation therapy after lumpectomy lowers the risk of the cancer coming back (recurrence) and makes lumpectomy as effective as mastectomy.

Whole-breast radiation therapy after breast cancer surgery is usually given as one treatment per day, 5 days a week, for 5 to 7 weeks. A Gray is the way radiation oncologists measure the dose of radiation therapy; if you're on a 5-week treatment schedule, 50 Gray is the usual amount given during the 5 weeks (2 Gray at each treatment). A supplemental "boost" dose may be included at the end of the regimen that targets the area where the cancer was.

Radiation treatment schedules were developed based on research results. But a 5- to 7-week nearly daily commitment may be difficult for some women, especially if they live far away from a treatment center. So doctors developed and studied a different radiation therapy schedule that involves fewer treatments with higher doses of radiation at each treatment, but the same total radiation dose. This accelerated, or hypofractionated, radiation schedule puts the same radiation dose into a 3- to 5-week schedule.

A hypofractionated whole-breast radiation schedule is appealing to doctors and people getting radiation for several reasons:

convenience: arranging daily trips to get treatment can be a problem for some women; fewer treatment days or a shorter period of time may be easier to schedule

if radiation is more convenient to schedule, it's probably easier for women to get all the recommended radiation therapy

"Recent long-term results from several large trials strongly support the safety and efficacy of accelerated treatment for most breast cancer patients," guideline task force co-chair Benjamin Smith, of the University of Texas MD Anderson Cancer Center in Houston, said in a statement. "Conventional therapy does not provide an incremental benefit in either tumor control or side effects compared to hypofractionated whole-breast irradiation."

To write the updated guideline, ASTRO experts reviewed 100 studies on hypofractionated whole-breast irradiation published between 2009 and 2016.

The guideline provides doctors with guidance for dosing, planning, and delivering whole-breast irradiation with or without an additional boost. Key recommendations in the guideline are:

Treatment decisions, including decisions between hypofractionated and conventional whole-breast irradiation, should be personalized for each patient.

The preferred hypofractionated dose schedule is 4,000 Centigray (cGy) in 15 doses or 4,250 cGy in 16 doses.

The decision to offer hypofractionated whole-breast irradiation should not depend on:

cancer grade, whether the cancer is in the right or left breast on previous chemotherapy

or previous or current treatment with Herceptin (chemical name: trastuzumab) or hormonal therapy

or breast size

For women diagnosed with DCIS, hypofractionated whole-breast irradiation may be used an alternative to conventional dosing.

For women diagnosed with invasive breast cancer, a boost to the area where the cancer used to be is recommended for cancers with positive margins, women who are age 50 or younger, and women age 51-70 with high-grade breast cancer.

For women who are older than 70 with low-to-intermediate grade disease, and women with hormone-positive disease with wide negative margins, a boost to the area where the cancer was is not recommended.

For women diagnosed with DCIS, a boost to the area where the cancer used to be is recommended for women age 50 and younger, women with high-grade cancer, and women with positive or close margins.

Three-dimensional conformal (3-D CRT) treatment planning with a forward planned, field-in-field technique is recommended.

"These guidelines apply to most women diagnosed with breast cancer," said Marisa Weiss, M.D., Breastcancer.org chief medical officer and radiation oncologist. "There are some exceptions, however. The ability to deliver a larger daily dose requires that your doctor design a radiation treatment plan that is very even throughout the whole area of the breast. Sometimes this is hard to achieve. In women with very large breasts or who have a large chest size, it may be hard to achieve an even dose, so your doctor may recommend a traditional dose schedule of 5 to 7 weeks.

"It is important for each person to get the best care possible for her unique situation," she continued. "The hypofractionated schedule is likely more convenient and less disruptive in your busy life. Still, if you have to have a longer treatment plan, don't think that this means you have a worse situation or worse outcome. These guidelines have no impact on prognosis or how well you do."

If you've been diagnosed with early-stage breast cancer that has been removed with lumpectomy and radiation therapy will be part of your treatment plant, it makes sense to talk to your doctor about the new ASTRO guideline and whether hypofractionated whole-breast irradiation makes sense for you and your unique situation.

It's also a good idea to talk to your doctor about skin reactions to radiation -- together you can develop a plan to ease any skin irritation that happens during and after radiation therapy.

redhead, you are welcome. I've wanted to know more about this as I had the hypofractionated radiation10 years ago.

This is what really interested me (from the above article):

"There are some exceptions, however. The ability to deliver a larger daily dose requires that your doctor design a radiation treatment plan that is very even throughout the whole area of the breast. Sometimes this is hard to achieve. In women with very large breasts or who have a large chest size, it may be hard to achieve an even dose,

Good luck and don't forget you can always have a second opinion.

I also am not getting hypofractionaction. Not sure if it is offered here - but I am large breasted and also am getting full breast radiation and axial and some clavical radiation because I had micromets in my sentinel lymph node and slight lymphovascular invasion so it might not have been the best anyway. I just had the positioning visit Monday and a CT then they will start radiation next week after they do their calculations.

My radiation center has only been here 5 or 6 years - prior to that there wouldn't have been a radiation center within 600 miles. As it is I drive about 15 minutes to get there so the longer time is not an issue. At least I say that now. The ceiling above the radiation machine has light panels which are currently showing cherry blossoms. I didn't ask if they change them but I guess I'll have them memorized in a few weeks.

Halfway done of 20 sessions( 15 plus 5 boosts) Nipple is pretty red and sensitive. A few jolts.I have been using Cavilon spray. Feeling a bit tired but not too bad. Back to work next week. Hope everyone else doing ok.