Decision/dilemma on radiation options

CurlytopL

Hi, all. I'm recovering from lumpectomy, and headed to radiation (no chemo needed per med onc). My initial biopsy/diagosis was done locally, but I shifted care to a well-respected national cancer center in a nearby city for surgery/followup/medical oncology. I've now met with the radiation oncologist at the national center, and was surprised to learn that they don't offer breast cancer radiation in the prone position. They do apparently have DIBH (deep inspiration breath hold).

The local community/regional cancer center (where I was originally diagnosed) DOES offer prone position, DIBH and " regular" supine position therapy; when I met with them prior to making the switch to the national center, the RO had suggested those as possible options. Naturally, no one can tell without a planning session which option would be best for a particular patient. My cancer is left-sided, so I'm especially concerned about sparing my heart from radiation.

My dilemma is - if I stick with the national cancer center for their presumably greater volume and expertise, I miss out on possible benefits of prone-positioning. If I treat locally, prone positioning is offered, but I forfeit the expertise of the well-respected national cancer center.

What to do? Thanks, and good health to everyone!

Runrcrb

“no one can tell without a planning session” is disturbing to me. If i were you I would continue to ask until a doctor can explain it to you in a way you can understand. And then I would go with that doctor 😀

You should be confident in your treatment plan. I’m sure there’s more than on radiation oncologist in each center you’ve visited.

Don’t settle or you will always have doubts and that is not healthy

Ingerp

I can tell you I did the DIBH two years ago and it really was not a big deal (and I am not a fan of being underwater). I actually practiced leading up to the first treatment but (1) the longest zap I had was 17-18 seconds (I think one was 11-12, and two more were like five seconds each), and (2) if something happens and you deflate too early, the machine will shut off automatically, plus you don't have to re-start the 18 seconds or whatever it was, you just pick up from where you left off (like if you were 10 seconds in and something slipped, you'd do another 8 seconds). After all that I didn't have one single problem with any of my sessions. As far as I know I had no heart issues as a result (and didn't expect to). DIBH is nothing to stress about.

CurlytopL

Thanks to both of you for your responses.

Runrcb, from what I've read, the planning sessions/scans in various positions are what enable them to figure out where/what the treatment beams will cross. Once they assess that, they can decide which positions/techniques deliver the right dose to the right areas, while minimizing scatter dosage to the unwanted areas, like heart, lungs, etc. Then the best option can be chosen. It's apparently quite variable from patient to patient. They can guess who might be candidates, but need those precise measurements to make the call.

Ingerp: Thanks for your first-hand info on the DIBH. I think I'd be fine with that, assuming my anatomy checks out appropriately. I've got pretty good breath control, and don't expect to have trouble with that kind of timing. I'd just be interested to know which approach would keep my heart and lungs more removed from the treatment field. Best of luck to you in your second go-round with breast cancer.

Happy, healthy healing thoughts to you both.

JosieO

CurlytopL,

I read your post and the responses and just wanted to add my two cents.

My diagnosis is very much like yours, EXCEPT I had one cancerous lymph node. So I knew before any planning was even scheduled that I would be treated in the supine position, I would have my axcilla and my clavicle areas radiated, and that I would get a large number of treatments. During the planning, I was tested with the DIBH, which made me a little nervous, but if I had to do it I would.

When my treatments started, I was not required to use the DIBH. When I asked, the radiation oncologist told me he had looked at both using/not using, and decided that the difference was so slight that he chose not to make me use it. His detailed description of how he saw the beams addressing my areas gave me confidence that he knew what he was doing and that I did not need to worry about possible harm to my heart or lung.

And it proved to be true. I finished my radiation a little over one month ago, and I was very pleased with how well I felt. (I only had some skin ulceration at the very end) I knew I had the right plan and an excellent radiation oncologist.

So I agree that the simulated planning should have the best possible option for you, so keep asking and discussing and feel confident in the people and facility you choose.

Best wishes

Ilomita

I am having a similar dilemma... The place where I am being treated does not offer radiation in prone position... but I keep hearing that prone is much safer, especially since my cancer is on the left.

I'm trying to find another place where they would offer the prone option, but it's hard to find out until I actually have a visit with the radiation oncologist somewhere...

Anyone know anywhere in the San Francisco Bay Area where they would offer a prone option?