Accelerated partial breast vs whole breast irradiation

Anonymous

Accelerated partial breast vs whole breast irradiation

Fixyourdog

Tomorrow I meet with my radiation oncologist to discuss the radiation treatment plan. I am 4 weeks post lumpectomy and I believe I meet all of the qualifications for accelerated partial breast irradiation (APBI). My rad onc had presented this as an option when I met with her pre-surgery, so I assume I'll have a choice tomorrow. I had just about talked myself into doing it, much attracted by being done in 1 week, but now I am having second thoughts. Whole breast irradiation (WBI) is always described as the standard of care, while APBI is still undergoing clinical trails. It was presented to me as having the same outcomes as WBI but I don't think any long term studies are available yet.

Also I don't think I am having chemo but won't know til this Friday when hopefully my Oncotype results are back.

Any advice or experience from you all would be appreciated.

Lorreo

Fixyourdog what did you decide to do? I am having a similar conundrum. Today I met with my radiologist 3 weeks post lumpectomy and found out that he and the breast surgeon had not communicated with each other about the fact that I wanted the brachy treatment and so the needed surgical pre-placement work was not done during the lumpectomy surgery. So basically I would have needed another surgery to place it or could now have the choice of WBI or the hypoaccelerated partial breast irradiation which in my area is part of the OPAL study through MD Anderson Cancer Centers. I chose the OPAL just this morning because like you was basically told that the rates of success are about the same as WBI. Now of course I am second guessing myself but I decided to do the partial because my pathology is identical to yours and I know going forward I will have frequent and thorough checks for any future tumors. My oncotype test came back with a low number, so no chemo, yay! I would start the partial breast radiation treatments next week and have 10 treatments. I do feel good about the choice, I just wish it were crystal-clear! Best to you in all of your decision making.

Salamandra

As far as long term outcomes like overall survival and distant recurrence/metastasis, radiation does not make a big impact for early stage breast cancer. They had to meta analyze hundreds of studies before they could make a claim that it actually has a statistical significance at all because in each individual study, the benefit was too small to be considered significant. That said, overall they say that there is an 87% chance that radiation will have a positive impact on long term outcomes for early breast cancer, and they think that for every 4-6 local reoccurrences prevented, 1 breast cancer related death is prevented. And radiation has proven very good at preventing local recurrences. On top of the (limited but likely real) long term mortality benefit of radiation, reducing local recurrence can save a while lot of stress, time, and money, for patients. This is all weighed against the short and long term risks of radiation. We still don't have a good grasp of the long term risks because of how long it takes to know and techniques have improved so much in the last 25 years.

This is all based on my own reading of studies, and I am not a doctor or scientist, just a patient with a way too long wait between diagnosis and meeting my radiation oncologist (Friday will be the day!) and too much impatience not to at least try to look for answers in the mean time.

From what I can see, studies so far show that whole breast radiation is better at reducing local recurrences and better in terms of cosmetic outcomes. There isn't evidence yet for whether it has lower long term risks. I am leaning towards whole breast radiation.

On the other hand, I am very keen to ask my doctor about minimal acceptable dose and fractionated treatment to shorten it as much as possible. I also have lots of other questions in terms of how it actually works and lifetime limits on radiation.

Hopefully this is helpful to someone... It is very hard to go so long on partial information without access to doctors.

cancersux2020

hi I was just offered the trial and was wondering if you guys did it and wondering how it went.

MinusTwo

Cancersux - these posts are all from 2018 so it's unlikely you'll get an answer.

However if you go the search section, there are a number of threads active on this topic. Or go to "radiation" under All Topics and search the posts.

cancersux2020

thanks