accelerated radiation schedule for DCIS

ElleDee

I've met with two radiation oncologists following a lumpectomy for DCIS.

The first recommended the standard five-days-per-week-for-four-weeks approach. The first three weeks would be full breast radiation and the final week would be a boost to the area where DCIS was removed.

The second recommended one week only (five days total) of generous partial breast radiation based on the results of the FAST Forward trial. (I'm not allowed to post links, but if you search this site for "Accelerated Radiation Therapy for 1 Week Offers Same Benefits as 3-Week Schedule for Early-Stage Breast Cancer" you'll find the article I was hoping to link to.)

In reading about the FAST Forward study, I notice two things: 1) the results thus far are for five years only, and 2) the women in the trial all had early stage invasive breast cancer, not DCIS.

I know that approaches to treating DCIS are changing. Meeting with these two doctors feels like I've walked right into the middle of the debate. I'm really struggling with which path to take. It feels like I'm betting my life on the decision in a very literal way.

Has anyone opted (or had recommended to them) the shorter, hypofractionated approach for DCIS? If so, what guided your decision making?

LIgma

Hi ElleDee,

I had stage 1 and had the accelerated radiation. I was told I would be given the exact same amount of radiation as the 20 day treatment. I go to a large NCI center. It was 5 days whole breast. One day boost. Side effects began 3 weeks after treatment. They were mild. A rash that seemed to move around the breast. No pain. No interference with everyday life. Just kept my cream on and it disappeared after 2-3 weeks. At my most recent follow up with my SO she said they are now testing 3 days! I was glad to have done it this way. Best of Luck!!

LivinLife

Hi ElleDee! I don't know about this for breast cancer though want to wish you well in making a decision. I appreciate you posting this question and Llgma's response as well. It helps all of us learn about what's out there. I hope you are comfortable with whatever you decide. I've heard of the accelerated radiation in other cancers - my sister had it.....

ElleDee

Thank you so much for sharing your experience, LIgma. I'm really glad everything went well for you.

Are you open to sharing where you were treated? I find that recommendations vary regionally, which is both intriguing and frustrating.

LIgma

Hi ElleDee,

I would be more than happy to share! I went to MSK in Commack, NY. I was treated with care and must say I was very pleased. My RO and the nursing staff went over everything before hand. If I had any questions, I usually received an answer via phone call within minutes of sending a message through my portal. I see others have had partial breast radiation but I was told I was having whole breast. Again, it was not bad. Feel free to ask me questions.

Lori

ElleDee

Hi Lori,

I really appreciate you sharing your experience--thank you. Once other question I have is this: Did your doctors tell you why they were recommended five days rather than 15? Was it due to COVID? Or convenience? Or because they thought you would have a better outcome with the shorter treatment?

Again, thank you,
Leslie

ElleDee

Hi Lori,

One more question. It sounds like you didn't have a boost to the area where the DCIS was removed. Did your doctors tell you why they weren't recommending that?

Again, thank you,

Leslie

LIgma

HI Leslie,

I had 1 boost for a total of 6 treatments. I would also like to clarify, I was originally scheduled for 20 rounds of radiation ( 15 rounds and then 5 boosts). At that time I was told I would be having whole breast. When I was approached about the accelerated radiation, partial breast was never discussed so I assumed it was still whole breast ( the machine did rotate to both sides of breast during treatment). However, it all went well and my side effects were minimal. Looks like more and more people are using the accelerated radiation. My MO thought it might become the standard of care.

Lori

ElleDee

Hi Lori,

Yet another question for you as I think this through: Was your radiation at MSK done in a face down position (prone) or lying on your back (supine)?

Many thanks!

LIgma

Hi Elle,

It was supine. They made me comfortable. Arms are up in a sort of stirrup above head but not stretched all the way out. I was covered at all times. Then they put on music. Really not bad at all.

Hope this helps you.

Lori

ElleDee

Thank you, Lori. I've read that the prone position helps minimize damage to surrounding areas, such as the heart and lungs. MSK is one of the places that pioneered breast radiation in the prone position, which is why I asked.

I've heard others says exactly what you did, which is that the actual treatments themselves aren't bad at all. For me, it's more the idea of the effect of radiation on the body in the long term.