IMRT vs. Regular Radiation for left breast DCIS

willheal

I was diagnosed in January of 2010 with DCIS in the left breast. Had a lumpectomy in February (a month ago).  The cancer was er and pr positive.  Next step:  radiation therapy.  I consulted with 2 radiation oncologists and I'm having trouble deciding which doctor to go with.  The female is very nice and has a good reputation specializing mostly in breast cancer radiation.  I had read about IMRT and asked if she would use that modality.  She said she could, and would need to charge me a lot more but that she felt she could do as well with traditional radiation therapy.  I am mainly concerned because she let me know that, although rare, when the left breast is radiated, there may be a slight damage to the heart which may show up even 10 years after treatment.  I had told her from the beginning that I would go visit another doc. closer to home.  She was gracious about that and left the decision up to me.  I was impressed that she was so well prepared before calling me in.  She knew my history and had looked at films, etc.  I then visited the closer/easier to-travel-to doc. I had been told by his nurse that he uses IMRT for left breast cancers most of the time.  When I asked him if he would be using IMRT to deliver radiation treatment, he said he would decide when he studies all films, etc. and begins the planning.  He was not interested in looking at the films at that point.  I called his office a few days later and spoke with the dosemetrist who sounded very knowledgeable and said most of the time he uses IMRT for left breast. I prefer the female (very experience with breast cancer radiation)  The male who was not that forthcoming with info. Said "you have been to other doctors so I don't need to go over everything with you".  I began to ask questions.  Female doc. offered information and answered questions well.  I prefer her but may benefit more from the type of radiation he offers because it is left breast. Can anyone shed some light, some personal experience or knowledge as to whether left cancer dcis is better treated with IMRT or if conventional radiation produces same results (both sparing the heart)?  Thanks

redsox

Both are making reasonable statements, the one who says she can probably do as well as with conventional treatment and the one who waits until after the simulation to say which method he will use. 

During simulation they usually take a CT scan that shows the exact geometry of your body including the breast, heart, and lungs.  Then they develop alternative plans for the angles and dose of different arrangements of the radiation beams.  The beams for whole breast treatment come from either side and cover the breast.  They will also deliver some dose to a part of the lung near the breast and may hit part of the heart near the breast when it is the left breast. They will try alternative arrangements of these beams to try to avoid the heart and minimize the lung, while still covering the breast.  Until they see your geometry and try alternative plans they don't know how well they can do at sparing the heart and minimizing the lungs.  With conventional treatment they will usually be able to get a good plan.  If not, IMRT might be a good option.

Most health insurance companies will reject claims for IMRT for treating breast cancer on the grounds that it is not necessary.  It is considerably more expensive.  A special case might be made or your company might be more lenient.

somanywomen

After my left breast lumpectomy, and having no knowledge of IMRT (Trilogy) vs the regular radiation systems, I went on line and kept reading that the IMRT should be less intrusive to heart and lungs..So that it the way I went for my 30 treatments..Mine were done with about 20 seconds of holding my breath during the radiation sessions while lying in a body form to fit me..I have to say that my se's seemed fewer than some with the regular treatment in my Dec 2009 rad group, but I have also changed my diet completely and I believe that really helped!..Make sure you know your rad treatment technique and who your techs are, that way if something is done different (as mine were one day) you can challenge it, don't just take it for granted that some new person knows your treatment plan....good luck....

willheal

Dear redsox and somanywomen,

Thanks so much for your reply.  This is my very first time using a chat room.  I couldn't get to sleep last night with so much on my mind.  This is unusual for me.  I guess I feel pressure to decide quickly.  I couldn't wait to log on this morning and see if anyone was out there and would respond. You both did and I am grateful for that.  I had a mammo yesterday which was requested by both rad oncologists I consulted.  Results will be faxed to them probably this afternoon.  I found out that the female doc won't be in the office all next week. (Today is Friday).  I was informed by her office personnel that if I decided on her and she got the mammo report this afternoon that she could conceivable leave the instructions to the planning people and set me up for the CAT scan even though she won't be there next week.  p.s. I think I will modify my original posting because it seems confusing.  Thanks again for your help.  Happy day!

sweatyspice

Willheal - I'm not sure if you know the difference and misspoke, or if you really don't know - so, this is a message board not a chat room.  There IS a chat room function associated with this site, though.  If you scroll up to the very, very, very top of the page you'll see a narrow black band, and one of the things printed in the black area is "chat rooms."  You can click on that to access the chat rooms.  In "chat," there is a "room."  You type something and everyone else who's logged into the chat room can see it.  It's in real time, unlike this message board where you have to wait to get a reply.

The bad news is that if no one's "in" the chat room with you, there's no one to talk to and no one will see anything you write.  You can tell when you "enter" if there's anyone else there. 

I've never used the chat room here, I tried once or twice but no one was ever around.  I do know others who use it though, so maybe my timing was just bad.

Enjoy exploring the chat function, and as you know, you can always post here - even if you do have to wait for a reply!

Best wishes to you.  

somanywomen

Willheal...I forgot to mention that after my 30 rads with tthe Trilogy machine IMRT...that I was shocked to say the least that my insurance co wants me to pay an office visit charge for each one of these almost a thousand dollars that will not be towards my deductible...Needless to say I am fighting these charges, my radiation was done at a Cancer treatment center and not the hospital..You might want to check with your Ins and make sure that this doesn't happen to you if you do choose the IMRT.....Keep us posted, the best of luck to you.....