APBI, Brachytherapy - anyone?
Comments
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My doctors are pushing whole breast irradiation, external beam radiation. I am freaked by the potential SE and bad outcomes. I am pushing them to consider partial breast irradiation, interstitial brachytherapy, Accelerated Partial Breast Irradiation (APBI), and the like. That approach seems to get most of the evil cells while leaving surrounding structures unharmed.
I didn't see a topic like this on the forum so I posted a new topic. Please share what your experience with brachytherapy has been, or whether you were informed about it or steered away from it, and why.
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Bumping myself - this post didn't get any views, let alone responses.
I'm new here, I'm open to suggestions as to how to get noticed and answered.
Thanks, ladies.
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AnneWisc - I have no experience with Brachytherapy. However I had IMRT 30 Rads which is a more targeted radiation. I was told it also protected my lungs and heart. I have had no problems since finishing on 12/23/10. My breast did tan somewhat and that has faded with time.
Good Luck!
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Hi Ann, Don't know anything about the brachytherapy because I had whole breast radiation so in no position to respond. Did you try going on the forum and searching by keywords? Don't know you(edited to say your) cancer type or status so offering an opinion wouldn't be very beneficial. Hopefully someone will be along soon to help you out. Good luck on your journey.
Maureen
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Hi Maureen - how do you search the forums? I am trying to find a post I read earlier today and I can't find the search feature!
There's a search at the level of the home page, but that only brings up articles, not forum posts.
Thank you in advance - if anybody else knows how to search the forums, jump on in, please!
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HI
I read only about it. It's a surgery, getting the needle with radio into your breast , leaving it for some time (?) then removing. Done with basic breast surgery usually.
I have had 30 rads, didn't badger me!
Best wishes
Usha
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Valgirl, thanks for mentioning that. I will research it.
Had lumpectomy last week, next week I go back to talk to my surgeon and I know radiation choices is coming up soon here. I'm afraid of whole breast radiation and want a more targeted treatment. One radiation oncologist said my DCIS was too superficial (close to the skin) to do brachytherapy. I'm planning to debate this and maybe ask a referral to someone who does more brachy, I get the feeling that the first doc I spoke to is not that experienced in anything besides external beam. She said "I'm pretty sure you will tolerate radiation well" and alarm bells went off - oh like she'll be there holding my hand when I get lung cancer or heart failure!
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AnneWisc - I thin it is very important to make sure you choose a treatment center/radiation oncologist who is experienced with the breast. Go for another opinion.
At the top right of the screen on this site is the search button. From there you can type in keywords that you want to search.
Good luck and let us know how it goes!
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Yep. Mammosite for me. 10 treatments over 5 days using a special catheter which is implanted into the void created by the surgical excision.
There is another company (whose name is eluding me) which has a different catheter, but the same general idea.
I think the newest version of this is the intraoperative radiation therapy (where the radiation treatment is done during the course of the surgery).
You'll find several threads talking about side-effects of their brachytherapy procedures. I didn't have any, and was really happy not have external beam radiation over a period of 6 weeks. You'll find some information if you search the site (at opposed to the forum), but I'd also try searching some of the other terms.
Best wishes!
LisaAlissa
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HI-
I am undoubtedly the only person on this board who has had both types of partial breast irradiation, so let's see if I can give you some ideas.
I also wanted mammosite - and was approved for it. I was stage 1, grade 1, and had waited far too long to get my mammogram (never find a lump in October) so needed rads to be OVER. Or else, they were going to lock me up.Had heard about brachytherapy from a cousin-in-law (DH has 32 first cousins) who had this treatment in New Orleans. She's 10 years out and doing just fine.
So I pushed, and they agreed, and inserted catheter, and I went for my first treatment. It's not wonderful, but the treatment is only a few minutes long, and they do an x-ray each time to make sure the catheter has not moved. However, they didn't put me on an antibiotic, and ended up with a messy infection, and they had to remove the catheter.
There is another balloon device called Concentra, that is oval, so it may work better for you.There is another partial breast option - I had it - it is the other arm of the Mammosite trial - 2wce a day treatments for 5 days. They do multiple views, so it's longer on the table, and there are position changes, but boosts and everything are included.
I am so glad I had this treatment, and would do it again in a heartbeat. My skin had no trouble at all - just a sunburn, and I healed within a week. My onc said I had the best results he had ever seen.
I know some other women who have had the Canadian protocol - 15 days, and out.
If any of these options seem good to you, I think I can find more information - just don't remember every detail now.
Sue
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Thank you, Sue (ICanDoThis) for a detailed answer. I see my radiation onc tomorrow for treatment planning. The "other arm" of the Mammosite trial you are describing, sounds similar to interstitial brachytherapy, is that right? Numerous fine catheters left in place for twice-daily treatments for five days? If it's not interstitial brachytherapy, please let me know the name for the treatment, so I can ask about it.
I am not a candidate for Mammosite, in the tumor bed, because mine was so close to the skin, the intense radiation would be too much for the skin to handle. Also, I have not heard of the Canadian protocol, can you tell me how the radiation is delivered? Is it external beam?
Thank you for sharing your experience with me, it's very helpful.
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No, the "other arm" of the mammosite therapy is partial breast external beam radiation, delivered tce daily for 5 days. I don't know why it's not more popular - except I know that my radiation therapists didn't like the repositioning. This is the treatment that I finished up with, and, while I would have preferred an internal treatment, it was very effective for me.
The Canadian protocol is the same external beam treatment, with a lower dosage, spread over more days.Sorry I didn't see this until now.
I didn't have brachytherapy - but I know that my cousin who had it called me as soon as she heard, so that I would know it was available.
Hope this helps
Sue
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Thank you, Sue.
Saw my radiation oncologist today. We agreed that partial breast radiation would be acceptable for me. She wants to do more research on interstitial brachytherapy for people with history of keloids (excessive scar formation) and wanted to be sure I knew about that possibility. She also would be open to the external beam partial breast method.
She said she had never had anyone be as "proactive" as I was. Is that a good thing or a bad thing, I wonder?
My planning appointment will be in a couple of weeks. Then, the actual treatment whether internal or external would be either one or two weeks.
I can live with this!
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Good visit with radiation onc. today. They are going to be able to do external beam partial breast irradiation, and I can come once a day for two weeks. I am very satisfied with how much they are tailoring the treatment to me. At first I was told they don't have a method to irradiate the breast from a prone position, but today they fitted me with a mold that will allow gravity to pull my smallish (B) breast with the nipple area (where the tumor bed is) as far from the chest as possible. Dr. Anderson is very caring and reassuring.
Supposed to start in about 2 weeks. Looking forward to getting this over!
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From what I understand brachytherapy can be done if you are in the early stages of breast cancer, you have had a lumpectomy, no lymph nodes are affected, you don't need chemo, and you are HER2 negative. I know of three types of brachytherapy treatments. They are Mammiosite, SAVI and Intraoperative. Mammionsite and SAVI are 5 day radiation treatment where a device is inserted where you had the lumpectomy and they radiate the site. The intraoperatvie is done during surgery when you have the lumpectomy. This technique is very new and very few hospitals/radiologists offer this treatment at this time.
I am working toward having the SAVI treatment. Both my Onco and Rad Onco feel I am a good candidate for the SAVI. I am currently visiting surgeons that are experienced in the procedure.
Good luck with your decision and your treatment.
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I had the SAVI. It was 5 days 2x a day. I had a BS who was comfortable using the device along with a radiologist who had done many such procedures. I had a great result from the procedure. Little tiredness, and returned to work right after the procedure. My one caution is do not have chemo to soon after having it. The plan had been no chemo for me till my Oncotype test came back in the gray zone. I unfortunatly had a Onc. that was no aware having chemo to soon could cause probleems.
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"The intraoperative is done during surgery when you have the lumpectomey. This techniques is very new and very few hospitals/radiologists offer this treatment at this time."
Actually, interoperative radiation therapy (IORT) is not new. It was first used in 1905 -- back then external beam radiation therapy couldn't reach deep tumors. However, it's true that it isn't very widely available in the US. In Europe, though, it's one of the preferred ways to treat breast cancer.
The main reason it's not used as much here is that radiation oncologists don't make as much money from IORT as they make from external beam.
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Cycle-path, I think what you are talking about is a 1 time radiation treatment to the area. I understand it is being done by a few Dr's no idea who does it. What I had could be placed at the time of the lumpectomy or right before treatment. In my case by BS wanted to be sure my SNB came back clear before proceeding with the contra device, so it was placed right before treatment. I will agree it is cheaper , but boy it sure is easier for the patient.
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Lucky for the ones who have Intro-operative rads available to them. My lumpectomy is scheduled for June 28th. If my final paths come back clear, I will have the SAVI device implanted July 21st and have my 5 day/twice a day from July 25 - July 29th.
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Good luck with your procedures, ktab96.
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Kira, yes, I'm talking about a one-time treatment done during lumpectomy.
ktab, if more people demanded IORT it would be available to more of us! I think it's an outrage that it's not more widely available. However, it actually is available in most states. You just have to search. Your doctor won't help, unless s/he is someone who does IORT. Sad but true.
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I have been approved for the SAVI. I am going to the BS on Thursday for him to insert the catheter and then go the the radiation onc on Monday. He will do the CT scan to make sure the catheter has not moved and then will do my treatment. My treatment is from Monday - Friday ( once at 8:30am and once at 2:30pm). I will have a film done before each treatment and then have to wait 30 minutes before the treatment. I was told to expect 11/2 to 2 hours for each treatment. I am actually going to work from home. I am going to be put on anitbotics so I don't get an infection and was told there would be drainage from the catheter. My doctor plans to use my sports bra to help hold the gauze in place. I have been told that I can drive. I am nervous but like ICanDo I want this over with. I refuse to let cancer take over my life.
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cycle-path, It came out just after my surgery. I think it would have been suggested by my BS. I would have done it with out a second thought.
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kiri, your doctor may not want you to know this, but IORT has been available for breast cancer for more than 10 years. And it really angers me that this procedure, which is better tolerated than whole or partial breast radiation, isn't offered to more women and more widely available!
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vnorman - your treatment sounds like it will be similar to mine. Once my surgery takes place, my RAD ONC wants me to heal for three weeks and also to have my final paths come back before the surgeon inserts the SAVI device. Once the device is placed, I will see the RAD ONC again for him to take a picture. I will then have my radiation from Mon-Fri. He said I should be able to wear a regular bra or a sports bra..which ever is more comfortable. He didn't mention leakage, but it make sense. I will ask the question when I go for my followup after surgery. Good luck on your treatment.
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ktab96 - i got my catheter inserted on Thursday and didn't feel any pain. My doctor doesn't believe in tape so packed it really well with gauze against my sports bra. He wants me to wear the sports bra 24-7. Today is the second day. I have some pain but am trying to do without meds. i had mine inserted in my left breast so i have to be careful what i do with my left arm. I start the rads on monday at 8:30am.
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Hang in there, vnorman. If you do have some pain, start with non-narcotic pain meds first before you move up to the heavy hitters. But it's ok to take pain meds!
I have my first external beam radiation on Monday. I'm a little nervous, I can't say I'm not. Radiation, the invisible killer, it's hard to think that it's GOOD for me. The protocol we agreed on is to only irradiate the area of the breast near the original lesion, sparing chest wall, bones, lungs and heart. Here goes nothing! Geronimo! (With apologies to any Native Americans in our midst... I just don't know of a synonym in our culture.)
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i just had my first radiation treatment. Actually treatment took 8 minutes but visit took 2 hours. I have to be back at 3:00 for second treatment. There was no pain and so far i feel fine. hope it lasts through my last treatment on friday.
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Just had mine too. I feel very funny (funny odd, not funny ha-ha) about the whole thing. I asked the doctor to go over with me the radiation plan, with visualizations of what area would be irradiated and what area not. It all sounded good ... still uneasy, though.
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I finished my treatments on Friday and then they took the SAVI catheter out. Oh my gosh did it hurt. I had taken two pain pills before my treatment but still experienced pain for about 2 -3 minutes. If I had to do it again, I would still choose the SAVI treament. One week of going twice a day versus 30 days.
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