Length of radiation treatment

Raysal

I'm 34 years old, diagnosed with IDC stage 2, 3cm 0/2 nodes, ER/Pr+ her2- oncotype 13. Next step in my treatment plan is radiation therapy. So my first hospital said 3 weeks, but where I went for 2nd opinion suggested 5 weeks because im under 40.

How do I know which protocol is better? I understand it's the same total radiation just spread out differently.

Salamandra

I'm 39 and am doing the 3 weeks plus 1 week boost. This is at MSK. I think my risk profile may be slightly lower than yours (older, 1.8cm tumor, oncotype 9).

From what I saw (and I'm no expert) and was told, the shorter schedule seems to be better in terms of side effects as well as impact on life in general. So I'd want to understand what the second opinion is basing itself on. Maybe he knows of some studies that others don't, or maybe he's currently conducting one on younger women? Definitely do ask questions util you feel like you have the information you need. A true choice means a meaningfully informed choice.

Both of them are effective for reducing recurrence. So I don't think you can really go seriously wrong.

Also I've just been reading about the new staging guidelines and it seems to me you're actually pathological stage IA or IB, depending on the grade of your tumor. (control-f page 630: Reference on staging).

Where is your first and second opinion from? Are they both NCI cancer centers?

AliceBastable

The radiologist where I'm being treated said the first amount they tell you is an estimate, and they don't know the true number of treatments until you've had your set-up session. Its based on the CT scan done at the time, plus where the tumor bed is located, node involvement, and other factors.

Raysal

Salamandra, I'm not in the US so no NCI.. however the first hospital is a university hospital in my home country.. the second opinion was MD Anderson. According to the radiologist the study was for over 40.. if I was closer to 40 she would have been more comfortable with the shorter session. Having said that the radiologist did admit that in UK the protocol has become 3 weeks regardless of age.

Ingerp

It can depend on breast size, and whether they do an accelerated schedule or not. I got the same amount of total radiation in 2016 and this year, but had 20 total sessions last time and 33 this time. Because I had chemo this time, my RO said my skin would not hold up as well so I got the longer, gentler schedule.

Salamandra

Raysal, would your local hospital be willing to follow the other schedule?

Thinking through, my 2 cents

From what I can tell, it's not that the shorter time has been shown to be less effective for younger women, but that there isn't enough data to support it being at least as effective as the longer time. In the absence of specific data, some doctors will be more conservative than others (or conservative about different things).

What doctors did find is that women, and especially younger women, were less likely to be compliant with the longer course of therapy. They attribute this to women of our age being more likely to be having to deal with childcare plus full time work plus other responsibilities, than older women who if they are not retired at least are may have older children, more financial security for time off, etc.

So younger women getting worse outcomes on the old schedule because they were missing treatments, and were more likely to comply with the shorter schedule and get a lot more benefit out of a complete short schedule than an incomplete long schedule. So on a population basis, there is real benefit for scheduling everyone for the shorter therapy (like it sounds like they do in the UK). But for a particular individual who would be perfectly compliant with the longer course, those statistics aren't really relevant.