Follow-Up To "NOW I Need A Compression Bra?"

Blessings, what the heck was up with the Kaiser person?? We've heard issues about Kaiser doing LE therapy by giving out a DVD...

I think you have a trapped pocket of fluid from the surgery. Is this LE, well kinda, because it's trapped fluid.

I'm currently seeing a LMT who is an RN and trained in LE and she's doing myofascial work on my scarred down side. My LE therapist is an LMT but she doesn't do myofascial work, and after three of my doctors noted how stuck down I was, I thought it was time to address it, and was terrified it would make my LE worse, but actually (knocking on wood here), it's helped. I see each LMT every other week. And my tissue is SOOOO much looser.

I think you're totally on track.

Yeah, with the pocket of truncal fluid, you're at higher risk for LE to show up in the arm, but it's not there, so just be diligent.

Blessings, I'm so glad! And the seamstress for $20 is priceless.

I am both enjoying and getting relief from the myofascial work. I now realize that there was a ton of scarring and radiation fibrosis. It took a session or so for me to trust her, but she's partially Vodder trained and my arm measurements have gone down! and my chest wall doesn't feel like a hard pencil eraser anymore! And, it's very very relaxing. Even when it pulls, it feels good.

I alternate: one week with the LE therapist and one week with the myofascial one. I'm high maintenance, but it's working.

I need to be more compliant with my personal MLD. I've slacked off and I notice a difference.

We were smack in the middle of the east coast blizzard and had no power/heat/hot water for a day, and that wasn't fun at all. Not ready to live off the grid...I'm appreciating the heat/hot water/lights.

Thanks for the update. Good news is always great!!

Hugz, I didn't see your post. In my experience, working with the rad oncs for three years, they didn't give a hoot about the fibrosis and skin and tissue changes I saw routinely. Nor did they care how much radiation they delivered to the level I/II nodes with standard tangents.

When Otis Brawley came to talk at the local med school (medical director of the American Cancer Society), one of the deans told him how his mother was treated with head and neck radiation for a non-radioresponsive tumor and the side effects were horrible, and her final years were full of misery. Routinely, I saw over treatment, IMO. (And since I left, that impression has been seconded by physicians I trust.) Now I got my rads at another practice, and that rad onc, while sweet, flat out told me that radiation NEVER caused LE....And I came into rads with LE.....She could have paid more attention to the tangents...

Recently, I found articles that chemo and rads work via the mitochondria, not the over simplified "they kill rapidly dividing cells" and this explains a lot of the side effects of both

http://www.cancer.gov/ncicancerbulletin/010813/page6

I am not a radiation oncologist, I just "played one on TV"--worked for one for three years taking care of his patients, before, during and after radiation. It was fascinating work for me.

Just found this article about lower dose radiation harming less normal tissue, too late for me....

Family Practice News

AN ANTONIO – A lower-dose, briefer radiotherapy regimen than is standard for early-stage breast cancer in the U.S. demonstrated comparable efficacy with fewer side effects at 10 years of follow-up in a pair of landmark U.K. studies."Long-term follow-up confirms that a lower total dose of radiation in fewer, slightly larger fractions delivered over a shorter treatment time is at least as safe and effective as standard 5-week schedules of curative radiotherapy in women with early breast cancer," Dr. John R. Yarnold declared in presenting the latest data from the U.K. START (Standardization of Breast Radiotherapy) trials at the annual San Antonio Breast Cancer Symposium.

Dr. John R. Yarnold

The historical standard of care for radiotherapy in patients with surgically excised early breast cancer is 50 Gy delivered in 25 fractions of 2.0 Gy each over the course of 5 weeks. That’s still standard practice in the United States.

In the United Kingdom, however, the standard nationwide is 40 Gy in 15 fractions of 2.67 Gy over 3 weeks. Radiologists term this "hypofractionation": delivering a lower total dose of radiation using fewer but larger fractions. Hypofractionation has standard practice in the United Kingdom since the National Institute for Health and Clinical Excellence–issued guidelines to that effect in 2009. Those guidelines were based in large part on the earlier, highly favorable 5-year outcomes of START A (Lancet Oncology 2008;9:331-41) and START B (Lancet 2008;371:1098-107).

The START investigators deemed it essential to conduct the new 10-year analysis because adverse effects of radiotherapy given for breast cancer can arise after the 5-year mark. Also, it was important to learn whether the early antitumor effects of hypofractionated radiotherapy persisted, explained Dr. Yarnold, professor of clinical oncology at the Institute of Cancer Research, London.

The two key findings at the 10-year mark of START are, first, that both breast cancer and the dose-limiting normal tissues respond similarly to fraction size, so there’s no advantage in continuing the 2 Gy fractions that have historically been the international standard; and, second, that a 15-fraction/3-week schedule is gentler on normal tissues and comparable in antitumor efficacy to a 25-fraction/5-week regimen.

The clinical implications are clear, Dr. Yarnold emphasized: "Patients can safely be treated to a lower total dose with fewer fractions than the historical standard of 50 Gy and 25 fractions. There are no detrimental effects of hypofractionation noted in any of the subgroups studied."

The 10-year rate of moderate to marked adverse treatment effects on normal tissues in START A survivors who received 39 Gy in 13 fractions over 5 weeks was 43.9% compared with 50.4% in those randomized to 50 Gy in 25 fractions over 5 weeks. The resultant 20% relative risk reduction with a lower total radiation dose delivered in fewer fractions was statistically significant. In contrast, the 10-year locoregional tumor relapse rates in the two groups were similarly low.

At 10 years in START B, patients who received 40 Gy in 15 fractions over 3 weeks had a 37.9% rate of moderate-to-marked adverse effects on normal tissues, compared with a 45.3% rate in those who got 50 Gy in 25 fractions over 5 weeks, for a highly significant 23% risk reduction. The relapse rate was 4.3% after 40 Gy and 5.5% after 50 Gy, a nonsignificant difference.

In both trials, all types of side effects involving normal tissues were significantly less common in the lower-total-dose, fewer-fraction groups. That includes brachial plexus injury, which has been a concern expressed by supporters of the historical standard regimen, Dr. Yarnold added.

Radiologists and surgeons in the audience called the 10-year START results "very, very important" and likely to be practice changing.

Canada has already switched from the historical standard to 42.5 Gy delivered in 16 fractions over the course of 22 days. Asked if he thinks U.S. radiologists, too, should change their practice in light of the START findings, Dr. Yarnold was diplomatic. "I foresee no scientific reasons why they should not consider that very carefully," he replied.

Follow-up will continue in the START trials, which are funded by the Institute for Cancer Research, Cancer Research UK, the Medical Research Council, and the National Cancer Research Institute. Dr. Yarnold reported having no financial conflicts.