accelerated radiation schedule

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 early stage breast cancer (including 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? If so, what guided your decision making?

Rubytoos

I did a deep dive into 1 week vs. 3 and ultimately decided to stick with 3. You receive 40GY in a standard 3 week course (don't know what the boosts involve) which means 2.6Gy per day. The one week course was 27 or 26Gy which would be 5.4 or 5.2Gy. So less over all radiation but a much higher daily dose. I really wanted to do the one week course because initially I thought less radiation. I did get a couple of opinions. But it is a much more concentrated therapy and my RO said the cosmesis would likely be much worse for me. The study, however, said that 5 years out, both courses of therapy were equally acceptable as far as tissue damage. But that is as far as it goes. It seems to me that 3 weeks is well tolerated by most people. And that may also be true of 1 week, but have read posts on the forum from people who feel they were "fried" by the more aggressive dosing. Not knowing which side you will treat, there are other issues beyond cosmesis, like sparing the esophagus, heart, and lungs. So these are the questions I would be most concerned with. It does sound like either course will kill breast cancer cells but at the same time you want to minimize collateral damage.

Gretchenbuddy

Ellerbe, I am doing the accelerated hypofractionated RT. I think I will start 10/25, but awaiting confirmation. They didn't make a decision until after the simulation and because we're going to 1 week instead of 3 I will get 2 more tattoos during what the call the verification, the day before RT starts. I am 63 years old and told I was diagnosed very early. Despite being HER2 positive, they all say the outlook is very good. I trist them and will follow their recommendations

ElleDee

Rubytoos, thank you for the response. I'm dealing with DCIS in the upper, outer quadrant of my right side so the heart is less of a concern than it would be if it were on my left.

Were there resources that you found particularly helpful in making your decision? I've read and heard skin burns and cosmetic effects can be worse with the accelerated schedule. I haven't found a lot that indicates whether long term effects (including the risk of more aggressive secondary side effects) are also exacerbated by the higher daily dose or whether the lower overall dose mitigates that.

This is the hardest decision yet!

ElleDee

Gretchenbuddy, thank you for the response. It sounds like you're starting radiation in the next week. I hope all goes well for you!

marinochka

I had also for DCIS 5 days radiation. I was suggested 3 days but i refused, i am not sure why. I think I thought i already agreed for 5 instead of 4-5 weeks, so I don't want to have even less days.

It was march of 2020.

My decision was because I was told it is almost as good as 4-5 weeks in terms of my risks of recurrence. The thing is (i hope they told you), you get the same amount of radiation BUT not the whole breast, just the area around your removed cancer.

The reason: they can not radiate the whole breast for this amount of days. But the % of risk you get recurrence close to where you had DCIS is much greater (don't remember exact numbers) than anywhere else in this breast.

Also I was going to take AI medication(which i am taking now). And general opinion of my surgeon, RO and MO was: you have to do at least either radiation or AI. They did not insist on both. So I decided on compromise. To have 5 days radiation and take AI.

In terms of toleration it was not a problem at all. I used all ointment recommended and did not have issues. I was concerned about it beforehand because I am light sensitive (I have cutaneous lupus). But I did not have issues.

Gretchenbuddy

Marinoçhka, thank you for sharing your experience and thought process. I'm still waiting for my confirmation phone call for me to start on Monday. Happy to hear you haven't had any major issues.

ElleDee and Rubytoos, I'll look forward to any additional info/insights you're able to share.

marinochka

Gretchenbuddy, you are very welcome.

Please let us know what you decide and how it goes?

Wish you luck with any decision you would make!

Rubytoos

I finish 3 weeks hypofractionated radiation treatment tomorrow and so far so good. I have some erythema on my upper chest where the skin is thinner. But other than that it has gone well. I am told that there could be reactions for the next couple of weeks, but truthfully this was the easiest part of the treatment so far, just time consuming due to the daily appointments. I am really glad I didn't push for a shorter regimen with higher daily doses. On the days I had a bolus my skin really got hot and early on I ran a low grade temperature. But everyone's mileage is going to vary...