Which Radiation Protocol is Right for Me?

MoJim

I was diagnosed w/ DCIS in Nov. I had a Lumpectomy done on Nov. 19 & had 6 sentinel nodes removed (all Clear). Even tho my Stage is 0, I had micro-calcifications which were high grade aggressive of the comedo necrosis type.  I'm going to have my tattoo's put on tomorrow to begin Radiation treatments. I've done a TON of research on the various lengths & strength of "Grays" given to women.  Of course, they want to fit me into that "cookie cutter mold" of 6-1/2 wks. w/ 33 total treatments which seems to be what they prescribe for everyone.  I am worried about the "burning" factor as I'm a blue-eyed redhead w/ very fair skin.  I've already had Basel Cell Carcinoma removed from my face. They told me I would "burn" due to my coloring.  The "Canadian" protocol of more RADs given in a 3 week period isn't an option for me because my breasts are large & dense.  I'm wondering if any of you have done the shorter treatment & what was your experience.  Studies done in he U.K. suggest that a low-dose radiation therapy schedule is a good alternative to the standard schedule for women diagnosed with early-stage breast cancer.

Treatment options studied include: *a total of 39 Gray in 13 treatments over 5 weeks (low dose); OR, *40 Gray in 15 treatments over 3 weeks (low-dose).  GRAY is 1 unit of radiation.

Any input any of you may have would be greatly appreciated as I have to make my mind up pretty soon as to what I want to do.  I will also add that I have come close to totally skipping the Radiation due to other major health problems I have. I am almost 64 yrs. old & live w/ my husband (13 yrs. my senior) who has 5 cancers himself.  I'm not sure I could complete 33 treatments if I burn as badly as I've seen some of my friends go through.  We have ALOT going on here, so I'm not sure what to do???

Thanks in advance for your help/suggestions!!

MoJim ~ (Maureen)

lyzzysmom

MoJim, So sorry you find yourself here. I too am a fair (freckly skinned) reddishy blond (at least until I started turning grey). Skin tone does not seem to play much part in how your skin react to rads. Some fair people, including me do not have a bad time (33 sessions) while sometimes people with a more olive tone may. It does not seem to relate to how our skin behaves in the sun. My RO said it would not cause skin cancer on my breast. My breast felt sore by the end of rads but not too bad at all and It quickly felt better. Everyone reacts differently but the most important thing was to use the cream that my RO supplied multiple times per day as instructed.

I do hope you find the best protocol that is most suited to you and wish all the best to you and your husband.

MoJim

Thanks for your reply.  It's good to know there is another "fair skinned" friend out there who's been down this road. As I wrote in the post, I'm very tempted to skip the RAD's, but have people "breathing down my neck" to do it.  If there is a shorter, lower-dose path to take, I am going that route.  I'm glad that you have your's behind you !

Maureen

Varod

Hi,

If you are concerned about skin toxicity than in general delivering the treatment with a lower dose per day is as important as a lower total dose.

In general for breast cancer, if radiation oncologists are concerned about skin toxicity (eg large breasts, retreatment situation) they would use around 2Gy/day or less. This is the standard 50Gy/25# for breast cancer. I assume the last 8 days of your treatment (to bring you to 33 total) are a boost to the tumor bed and I can't comment on why they recommend that in your specific case.

You've done really great research into looking into shorter regimens. In the landmark "Canadian" study of 42.5Gy/16#, there was no difference in acute side effects vs 50Gy/25#, so it just showed that it's ok to bring women in for a shorter period of time. I'm less familiar with the START A and START B British trials of 40Gy/15# or 39Gy/13# but they may have shown a small cosmetic benefit in the shorter treatments. However in our institutional experience women with large breasts (> 40 chest or >D cup) tend to do worse with the shorter treatments (more dose per day = more acute side effects, which are already worse in large breasted women), and we always recommend the longer course for them.

Hope that's clear. Essentially, when radiation is delivered the total dose as well as the dose per day is considered in calculating it's effectiveness. A formula called biological effective dose is used for this. 42.5/16 vs 50/25 are very similarly effective so neither is really "low dose". Even though the total dose is lower, since it's higher dose per day the side effects balance out.

WinningSoFar

My RO told me that fairness has nothing to do with radiation burns (seems to have more to do with amount of skin exposed). I am white to the point of blueness and I never had rads burns either to my breast (in 1999) or to my back/hips in 2012.

MoJim

Varod: Thank you for the great information. You sound like a medical professional ...??? I've had my 2 "pre-therapy" appt.'s this week & begin the "real thing" on Monday. I showed my research to the Oncologist this week & he listened, but said due to my coloring, breast size, & overall health, that I'm not a candidate for the shorter term protocols.  Just as you thought it would be. I'm a petite woman, but am a DD cup size.  They fit a special "cup" over my breast that straps around the back & fastens so my breast doesn't fall to the side.  The Onc told me there was really no other way to do it in my case other than the "traditional" 33 treatments w/o causing my skin & health more harm.  Honestly, I don't think my body is going to "survive" the entire 33 treatments.  If I can get 25 tx in & then get the booster dose, I feel I will be doing "well."  My neck & back are already screaming from laying on that table just 2 days this week.  I hate to be a complainer as there are other women going over there for Chemo who look so frail & sick.  I decided a couple of years ago that I would never put myself thru Chemo.  I've seen my husband & dear friends go through it & it is brutally difficult.

Thanks again everyone for your input!!!