Hypofractionated radiation therapy

Greyt2mphrn

Hi there. Is anyone doing the Hypofractionated radiation therapy? I am scheduled for 19 sessions but everyone I know is getting 33 sessions. My RO gave me information on it and it s elms to be equivalent to the 33 sessions, except with less side effects such skin irritation, burns, etc. My friend ( who I went med school with and is a RO) said he only does the 33 sessions because that is what he was taught and has had a good experience with. I understand it is widely done in other countries but not in America. Am I being used a Guinea pig? Please anyone- can you tell me about your experience with it- gulp and if you'd had a recurrence.

heidi16

I am getting hypofractionated radiation, too. Had 5 sessions so far. According to my oncologist it can only be given to women who are petite enough. It is the same dose as in the standard 33 treatments but in a shorter period of time.

ChiSandy

I am by no means petite (I’m short but zaftig), but I had hypofractionated rads--16 treatments, no boosts (because, basically, they’re all boosts). My RO told me I was a candidate because my tumor was small, Luminal A, node-negative, located off to the side and I’m over 60. (He was part of a recent trial that showed that for those women over 60 with tumors like mine, partial-breast hypofractionated rads to the tumor bed resulted in survival rates identical to whole-breast regular-dose rads).

Cowgirl13

I also had the hypofractionated radiology, 19 sessions--it was a piece of cake. I highly suggest.

BrooksideVT

Me too. As ChiSandy pointed out, your cancer has to fall within certain guidelines, but as far as I can tell, this is becoming the standard treatment for those for whom it is technically appropriate. This approach is not that new, and oodles of encouraging statistics have been published. If you are concerned, do gently grill your RO, and maybe seek a second opinion from someone in another practice as well.

Greyt2mphrn

it is nice to know that you all have or are having the hypofractionated radiation therapy. The problem I see for me is that I am node positive- 1 micromet in 7 lymph nodes and getting whole breast radiation. I just wonder if I am getting enough care- no one wants more radiation than necessary but I worry about having that micromet and length of time I had waited between end of chemo and now. My RO is also doing this reduce complications that could be life-threatening.I have read all the studies, especially the START 2 trials and it seems promising. But no one wants to be 2,3,5,10 years down the line and they discover it was the wrong thing to do for your cancer. The problem is that most- not all of the doctors recommend the 33 sessions. The micromet and Luminal B nature of my tumor (ER+, PR- and Her2-) also concern some of the RO. But I feel stupid saying, "Gee, I think I need more radiation.

heidi16

This thread prompted me to research more about hypofractionated radiation therapy. It seems like the eligibility criteria are;

• age 50 or older
• node negative and the cancer has been removed with lumpectomy
• no prior chemotherapy

I am 41 and had chemotherapy.... How old are you ladies and did you have chemo?

Greyt2mphrn

The START B trial had women with node positive and prior chemotherapy in them. I believe the recurrence rate was similar or just a little bit better. I don't remember whether the age was above or below 50. I think that might be something that would concern me about your case. I am very worried about the micromet even though I did not have LVI. I can't do this "cancer" thing again. And you only get one shot at radiation therapy so you have to get it right the first time. My tumor was IDC 2.8cm and DCIS 3.5 cm with a sprinkling of LCIS to complicate the whole mess. And nothing, not even radiation, does anything about LCIS. I just don't want to screw this thing up

BrooksideVT

I was in my late sixties with 10 isolated cells in one of two sentinel nodes, which is technically considered node negative.

Grey, perhaps you might post on one of the Canadian threads, as this approach has been done there for quite a while longer than here.

Positivepower11

Hi I am getting 15 radiations, I have 3 lymph nodes positive . My RO is the chair of Radiology of a top hospital and believes this best plan for me, includes boost in the 15. I Think this is the way forward  

heidi16

Positivepower: I am also treated at a top hospital (Dana Farber in Boston). May I ask you your age?

Positivepower11

53

Positivepower11

And I am starting 10 days after finisihing chemo.

heidi16

Brookside: Where can Canadian threads be found?

Grey: Thanks, in the START B trial the women were aged 20 and up. However, only 20% of the total sample were under 50 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60348-7/fulltext

Positivepower: Did you ask your RO why hypofractionation was preferable over conventional radiation in your case?

Positivepower11

Heidi I did not I know another RO who is also very well established ( friend) who had also suggested that 3 weeks plus a boost is now the way to go and gives better results. I was just happy with the 3 weeks and am happy to get done with it.

However, I was warned that they are not sure about the lymphedmia as the trial has not studied if the risk is increased or not and I am hoping not.

heidi16

Positivepower: Thanks, that makes me feel better. I was also just happy to get a shorter treatment. According to both trials this treatment seem to give a slightly better prognosis and much less side effects so hopefully same case with lymphedema.

BrooksideVT

Heidi, to find the Canadian threads, go to "All Topics" in the box at the upper left, then scroll down to the Community section.

LoveMyFamily

I'm having this type, too... 20 sessions total including 4 boosts.... 13 done, 7 to go. I also am not petite. I've never heard that pre-req before and would be curious why your oncologist said that. There's a recent article in the news section of this site that details the requirements for this type of radiation. I have light (not super fair) skin and so far I'm holding up well. Right after treatment I'm reddish and swollen but that seems to fade within a few hours. How are you doing?

Greyt2mphrn

I started a post but then my tablet froze! Well, where was I? Oh ok. Can I still blame it on chemo brain? My problem is that although I do research for a living, I do not want to be first out of the gate. I like to stay safe and sound and quiet. I wasn't given a choice- I want to throw everything I can at this cancer so if it comes back, I don't do that the "shoulda, woulda, coulda". That said who wants to say, "Please can I have more radiation?" We will just have to have faith.

heidi16

LoveMyFamily: Large breast size or large chest wall separation, is associated with greater dose heterogeneity, thus the daily and total doses for hypofractionated radiation will be even higher at these "hot spots."

Greyt2mphrn

As a Black woman, I have large breasts and a dark skin. I was overweight but now I am trying hard to get my weight under 110 pounds. After only 3 sessions, I am struggling with nausea and tiredness just from stress. I am being watched closely for any issues.

heidi16

Grey: I am sorry to hear that you are suffering from tiredness and nausea. I have been extremely fatigued, too but my RO said it is too early to be caused by the radiation. She said it could be late chemo effects (last tx was 5 weeks ago). Did you have chemo and/or Herceptin? Does your RO use hypofractionation on all patients?

Greyt2mphrn

My last chemo was months ago so I can't blame it on that. I talked to the RN about my RO. She does use hypofractionated radiation on most of her patients. Yesterday and today again I barely made it home before getting sick to my stomach and then passing out cold. I wake up in pain. The RN thinks that the nerve endings are irritated at the lumpectomy site but I can tell my breast feels warm to the touch and is starting to get a little red and painful. Today was hard. I feel very depressed

Cowgirl13

Grey, please talk to your RO tomorrow. I've never heard of this.

azrescue

I was very interested to read what you all had to say about this treatment plan. I have met with two different RO's. All of my treatment up till now has been away from home (4 1/2 hrs). However the radiation schedule complicates the traveling. But my family & I are willing to do so if we feel that means better care. I do not want to go through this again. So the RO at my treating facility is recommending 6 weeks of radiation (5 weeks with 1 week boost). They would be using the breath hold technique & would incl the intermammary lymph nodes. She said they are particularly aggressive with me being triple negative. Today we met with a ro here at home. He is recommending 4 weeks (3 weeks with 1 week boost), no breath hold, & the intermammary would only be what just does fall into the field. He said he's been using this for several years now. Based off the Canadian studies. And it is what he uses on most of his patients. My cancer was on the right side so the breath hold may not be as important. My dx was idc stage 3 with positive lymph nodes. The original tumor was 5.8 cm. I have already done my chemo. And I am 3 weeks post surgery (bilateral mastectomy with axillary lymph node dissection). I did have pCr !!! . And I am triple negative. I have read through a couple articles in regard to the Canadian study & it seems like there is something to the 4 week treatment. But ... I didn't see anywhere that it said anything about triple negative. Big decision. Interested in your thoughts. Thank you.

ChiSandy

I was not told to hold my breath at all. (The tumor was in the R breast). I am 65 (64 at the time), and very, very large-breasted: 38I. Fatty rather than dense breasts.My RO did not seem concerned about that.

Greyt2mphrn

Hi there. Cowgirl- Thank you for your concern. I met with my RO yesterday. I have some side effects from other medications that I am taking plus I just have a stomach that shows stress that way. I started taking my AI because I waited to make a decision about surgery (bilateral mastectomy vs radiation) before being forced to choose radiation. Plus I have been reading about skin reactions from AIs on another discussion board. The nerve endings in my scars are reacting to the radiation and causing pain. My RO said she is going to watch because she does not want me to start having lymphadema in the arm.

Azrescue- I would check with the RO that wants to do the hypofractionated because both the Canadian and UK START A and B trials went up to Stage 2 BC. Stage III may be different ( or are you grade 3? I get those mixed up). I think there is some difference in the radiation when they have to do the clavicle and intramammary lymph nodes.

I don't hold my breath but I also don't take very large breaths normally. And I am large breasted too. 44 DDD before surgery- who knows now after lumpectomy?I can't bear to look at either breast. I feel like they betrayed me.

LoveMyFamily

Starting on the 4 boosters today... will be done Tuesday, if all goes well (the control panel went down the other day and I almost didn't get my tx, but the repair person got it up and running again, whew... doesn't bode confidence, eek)... Heidi, I really didn't get what you meant above... can you translate? I love to learn the science behind things but sometimes don't get it.

Anyway, I'm happy I got the shorter course. 20 tx total. I'm a little tender but it's not too bad.

Hope it's going well for all of you!

Cowgirl13

Grey, so glad you could see your rad onc.

BTW, I had rads on my left breast and did the breathing thing. I think its call gated breathing. This is to protect your heart. Did really well with it. This is a great thread.

Greyt2mphrn

I met with my RO and I told her it was starting to hurt. I also told her about the nausea- she told me ( and I found out on breastcancer.org) that it is a common side effect from the AIs. That's what's why they usually have you wait to take them after radiation. The breast is starting to get red and painful . My side effects are starting to become "concerning". Decisions will have to be made this week.

LoveMyFamily

2 more boosters to go and then that's all! didn't anticipate having to get 2 more dot tats for the boosters... total of 6. have an annoying rash under my arm. can't wait to shave again... in a few weeks