Advice please “Canadian” (21 days) or “American” (31 days)

Amrie

I will start radiation next week and my doctor told me last week I had the choice of 21 or 31 day radiation. She did not recommend one over the other but only stated that in 15 year studies the results from studies were the same. Today she said she prefers I go for the 31 days as it is not as intense. Does anyone have any experience or advice

Georgia1

Good morning. I did 21 days after three very respected hospitals said it was just as effective with fewer side effects. It worked out great for me and of course it is way more convenient. I'd definitely recommend it.

Ingerp

I believe the Canadian protocol has become the norm—so named because some patients there have to travel such great distances for tx that many were not completing the longer course. I had the shorter course two years ago (we didn’t even discuss going longer) and will do it again this time. I can believe the SEs might be a little gentler with the longer course/lower dose but going five days a week *is* kind of a pain.

TheSwedishOne

If I understand things correctly from my doctor, the protocol of using less treatment days (but with an equal total amount of radiation) has been in use for at least a year or so in Europe. Maybe that can help you in making a decision?

Egads007

As Ingerp said, the daily back and forth can be tiresome. I was happy to go but it did wear on me. What really rotted my socks was the cost of parking. If I remember correctly it ran close to $500 total. I went for 25 treatments (5 days a week over 5 weeks). I was in and out of the building generally within 30 minutes. That averages $20 for the half hour I was there. To add insult to injury that rate was 'discounted' for those going through treatment. There has been a lot of controversy over this issue which the hospitals and govt seem to ignore. I was fortunate enough to be able to afford it, but there are many that can't. Shameful. So my advice to the OP is whatever choice you make on timing, check into how much it may cost you to do so. If the results are going to be the same the financial end of it might be part of your consideration.

I don't even want to think about, never mind tell what it cost me during chemo at a different facility.Ugggg.

VL22

I was told I could do the shorter method and was so happy. Then found out the RO changed her mind - cue the devastation. When I asked why she said not because the “Canadian” method was less affective at destroying cancer cells, but because the cosmetic repercussions for years out are unknown. So being I’m young and had a lumpectomy she thought this was a good idea. Maybe it doesn’t make sense, but at the time I wasjust like “whatever”.

Amrie

VL22 - that is what she told me as well, due to the cosmetic reasons and that my surgery was more intense and thinks the less dose is better. Makes me wonder ;-(

kaywrite

There is a new radiation protocol for "hypo fractionated" radiation, which increases the radiation dosage per visit, but decreases the number of days for treatment. As far as I can tell it has nothing to do with Canada or the United States. As I understand it, radiation doses are measure in "grays," with a customary treatment plan calling for 2 grays of radiation per visit. However, by increasing the grays, the number of visits decreases. For example, I had 21 radiation treatments - the first 16 were whole breast @ 2.66 grays per session. The final 5 were boosts, @ 2.20 per session. But it's not for everyone. Hope this helps. Here is the citation:

http://www.breastcancer.org/research-news/accelerated-whole-breast-radiation-new-standard

Amelia01

I was prescribed 15 sessions of dose dense rads. I’m in Europe and my RO is one of the most noted. I am trying to get them done in the US (personal reasons) and was told that it would be the standard 33.

Kaywrite- what do you mean it isn’t for everyone? Is it harder on the body?

Sandy71

I think that hypo fractionated protocol and 21 day 'Canadian' protocol are the same. I will be having 21 days , 15 to whole breast and 5 day boost to cavity. My RO told me that this was becoming more of the standard of care lately and he is preferring it because research is showing that it is just as effective as 31 day treatment. My radiation therapist actually told me that me that women who have 21 day treatment tend to have fewer skin issues.

Cowgirl13

I had the Canadian protocol 19 rounds or so. This was 8 years ago and it was a piece of cake. My skin didn't burn at all.

kaywrite

Hi Amelia - re hypofractionated radiation not being for everyone, I was making a general statement based on my perception of the article. My takeaways were: accelerated radiation worked as well as longer courses; is available to a much larger group than the previous guidelines it replaces; but was still on a case by case basis. An example given in the article is:

"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."

Paco

I had the hypo-fractionated (Canadian) protocol of 15 sessions plus 5 boosts, for a total of four weeks. I was pretty red and sore by the end of it and for about a week thereafter, but healed up fairly quickly. I finished about 3 weeks ago, and there is no sign of any lasting effects except for maybe a very very faint tan in the area radiated.

Egads, I hear you on the parking. The parking ramp was something like $8 a day but luckily for radiation patients, we are given a parking pass in a special adjacent parking lot for the duration of our treatment. It was quick in and out and zero cost. I appreciated that for sure.

striveforhealth

Searched for 21 day rads with boosts and found this thread. Thanks ladies who contributed. It was very helpful.

I will be starting the 21 day rads to include 5 boosts on Monday. Glad to be moving forward with this phase of treatment.

Best wishes to everybody else.

berries

I am in a study right now comparing exactly this. I am in the 21 day arm (thankfully!). My last 6 treatments start next week. My RO (one of the best in the country) also said that there is not much of a difference, if any, in the data they looked at comparing 3 weeks vs. 5 weeks.