Winter 2015-16 RADS

Saw my RO today and we schedule my planning session for 12/21 and I'll start radiation a little earlier than I figured but that's fine with me. Begin 12/28 and I'm down for 6 1/2 weeks (33 treatments). He did say it there was a slight possibility that after treatment begins we can re-evaluate and possibly do just 4 weeks of treatment but given my size and size of my breasts he doesn't think that will happen.

I had the 3DCRT--it's a shorter profile of more intense external radiation to only the tumor cavity and a margin around it. Some ROs do it for only a week (2 sessions a day, same sched. as brachytherapy), but mine does the Canadian protocol of 16 treatments (3 workweeks + 1 day). Even though my “radiation buddy" (another patient who has the same surgical/medical/oncology team and had her lumpectomy a week later than mine--we had appointments back-to-back and got to chatting in the waiting room) is a couple of months older than me, had the same Oncotype score and histology (ER+/PR+/HER2-) and also had grade 2 node-neg. clean-margin IDC, she is getting the full-course meal of 33 whole-breast treatments. The difference is that her tumor was >2cm. and she was therefore stage IIA; her tumor was closer to the center. According to our RO, I was offered the shorter intensive protocol not just because of my age, tumor grade and oncotype score, but also because I was stage IA and the tumor's location (upper outer quadrant, close to the surface) and size relative to my breast size was optimal for partial-breast radiation. Had the tumor been larger, located closer to the center, and my breast small I would probably have not been offered the option of partial-breast radiation. My RO participated in a larger clinical trial of partial vs. full rads for low-Oncotype women 60 and older, and the results (data is being prepared for release) were identical as to recurrence and survival.

As to other radiation therapies, I had asked about IORT and brachytherapy at my first surgical consult and pre-op “teaching session" with my bs' nurse. The Evanston branch of Kellogg doesn't offer either. My bs said that IORT keeps the patient under anesthesia too long, and doesn't appear to have recurrence-prevention stats comparable to external rads; and in her experience, it and brachytherapy carry a higher risk of infection, internal scarring and seroma formation, and brachytherapy is uncomfortable and inconvenient for the patient since sessions are twice daily and must be several hours apart (despite being only one M-F workweek), with the patient in relative isolation because she's radioactive while the seeds are in the catheters and each session is longer than external treatment. She must either hang around the hospital all day or go home or to work and come back--which makes it inadvisable to try to work during that time. They've found that catheter insertion and withdrawal can be somewhat painful and that the catheters must stay in for the entire week--they are rather cumbersome and uncomfortable for the patient during non-treatment hours (including overnight). The shorter treatment period of one week offers no advantage and more side effects than three weeks of external-beam hyperfocused therapy, other than duration--recurrence and survival were also similar, but complications were more common. Because of my large breast size and the fact I get asthma, I had asked about prone rather than supine--Evanston didn't have a table that could do that, but they would have been willing to let me transfer to a different facility were I to be getting whole-breast (especially on the left).

With external-beam radiation, you will feel nothing while it's being administered. Each “zap" is 30 seconds or shorter. With partial-breast, if you're going to get skin issues (I didn't--my breast is redder and tanner but the skin wasn't tender, itchy or peeling) and fatigue, they won't usually happen until after treatment ends, and they will be fleeting compared to those of whole-breast.

"DD boobs?" I wish. I could have bought bras off the rack at any dept. or discount store. How’s 38I sound? DD would be my goal were I to get reductions!

Oh, and I too have had scoliosis since childhood (though orthopedists told my folks it was too mild to treat). When they were positioning me on the table to straighten me out, it felt like I was instead being pulled into “Elephant Man” mis-alignment. I’d never had much trouble with it, except right before my first knee replacement surgery, when they were giving me the epidural--they missed by a hair and it felt like I had stuck my spine into a light socket. They had to do it under portable fluoroscopy. (When I had my C-section decades earlier, the anesthesiologist hit her mark on the first try--maybe she’d eyeballed my posture and noticed the streak from my bellybutton was not straight).

I wasn't told to avoid skin-to-skin contact as the underside of my breast (much less the crease between it and the midriff) wasn't irradiated. I also wore a bra or shelf-cami (still do) 24/7 except in the shower. Those who did have radiation in that area reported that tucking a soft cloth under the breast did the trick; some wore a bra over the cloth, some wore a soft cotton tank or tee beneath the bra. The soft stretch knit front-close leisure bras I wear to sleep are by Leading Lady, available on HerRoom.com, FullBeauty.com (formerly Roamans), and BareNecessities.com. They're pretty cheap, in the $20 range, and come as large as 44F/G/H. The camis I bought at a breast cancer boutique (Second Act) in Chicago are by Amoena--they're pretty pricey and run a couple of sizes smaller than your normal blouse or shirt size (I'm a 14/16, but I bought 20s and they're snug), so it's best to buy those in person.

--->EDITED to change “was irradiated” to “wasn’t"

StefLove, don't worry. If the stickers come off, they will remark you and put new on new stickers. I had treatment #4 today and they told me that sometime next week they will probably do tatoos so I won't have to worry about the marks. I am getting my treatments lying on my stomach, so all my marks are on my back, making it kind of hard to see if the stickers come off. I felt terrible because I did the same thing and used lotion after they marked me the first time and the marks came off! They weren't going to cover the marks with stickers at first because I am sensitive to adhesive, but they used Tegaderm which has worked great. I was told by my MO to only use Aloe gel and that if I had any serious skin reactions they would prescribe something for me to use. It's too early to tell what if any reaction I will have, but I do feel that my underarm is a bit irritated. I was tired the other day and a bit irritable, but I think that it was more emotional fatigue than physical fatigue. Sometimes this whole cancer thing gets a bit overwhelming and I think that sleeping is my way of escaping from it.....

Hi ladies, I met with my RO today, and have my CT next Wednesday. The RO said it will be between 16 and 34 treatments, but will have a better idea after CT. I most likely will start treatments the week of December 14th. Good luck to everyone beginning treatment. Have a great weekend. Patty

Hi all. I managed to work full-time all through chemo, although the week after treatment I worked half days with sick time, and was lucky enough to be able to work from home. I live in the mountains of Colorado and will have to drive 1.5 hrs. each way to Denver for rads, but I may stay there with my mother sometimes if the winter roads are bad for driving. I'm enjoying finally feeling like a normal person again after finishing chemo, so I'm hoping rads fatigue won't hit me too hard. We'll see, but I think I'm more worried about that than skin irritation. Planning meeting with RO on Monday. Lots of good info here already, and thanks everyone for sharing. Best to all for a nice weekend.

Dear Cardinal, Welcome to the community. We are so glad that you have already found the boards to be helpful. We look forward to hearing from you and seeing you here. Good Luck with starting treatment. The Mods

funny..the range of what they tell you! My rads tech told me put aloe gel as often as possible. RO says 3 times a day everyday. Nothing about moisture underneath. Wouldn't it be nice if the advice was consistent!?!

Hey...am in the Fall Rads group but actually starting with first treatment Dec. 7 and would appreciate joining your group as well.

Does anyone know why some of us are receiving radiation laying on their stomach and some get it laying on their back. Just wondering.

I'm experiencing stomach and swallowing issues which isn't all bad since I'm down about 12 pounds. The most bothersome SE I'm experiencing is spasms to my esophagus which has caused painful hiccups and a weird sensation like someone has their fist in the middle of my back, painful pressure.

My RO called to see how I was doing after my 9th treatment. After explaining my symptoms he prescribed Magic Mouthwash...to swallow. I've only heard of MM in conjunction with chemo and mouth sores, so this surprised me. Anyway have only tried it twice so far. Just curious if anyone else has tried MM and if it worked.

Hope you are enjoying the weekend.

Amy

Making meals ahead is a great idea. I usually make stews and sauces like these. Flavorful but you can adjust to keep them from being too spicy.

http://allrecipes.com/recipe/216312/moroccan-chick...

http://allrecipes.com/recipe/174543/slow-cooker-bu...

In general, I love this website. Make sure to check out the other cooks' comments before you go for it

PattyMeg- Sounds like you are being so smart about getting your ducks in a row- especially with the holidays approaching. I like to keep taco soup, white chicken chili and homemade spaghetti sauce in the freezer....for those crazy weeks, for friends in need or...for now with rads coming up. These are things I can just add a salad to- or make baked ziti and taco salad to change things up with leftovers. The allrecipes site is good as well as Pinterest for all things crock pot and/or freezer ready. I also usually have a meatloaf and mac and cheese in the freezer as well.

Made a white bean/ham soup last week that was delicious. Got a ham bone (or 5) from Honey Baked Ham shop in our town...used one for the soup. Keep the ham bones in the freezer....there is usually a good bit of meat on them, they are less than 5.00 apiece and they don't have to be thawed if you are using them in a soup or stew.

Hope all goes well for you!

I can only reiterate what my RO told me: because of my age, overall tumor profile, negative nodes/clean margins, tumor size relative to my breast size (and there's quite a difference between DD and H/I), and tumor location he concluded that whole-breast radiation would not be necessary; and that for patients like me (age 60+, slow-growing small tumors) 16 stronger treatments were as effective as 33 standard ones. He gave me a choice between the two protocols, and I opted for the shorter high-dose partial-breast one. The fact that he had participated in the recently-concluded multi-center trial--which trial confirmed what he had told me--was the clincher for me. Obviously, had my entire breast (rather than the tumor cavity and a small additional margin) needed irradiation, the higher dose would have been a problem. But because my tumor was located less than 2cm beneath the skin and on the upper outer quadrant, it was in an ideal location for partial-breast irradiation.

As to breast care, both he and the techs & nurses told me that I likely wouldn’t have to use the Aquaphor they gave me, but so long as I didn’t apply it within 4 hrs. before treatment it wouldn’t hurt. (Remember because my breast center took part in the trial they’d had specific experience from which to refer regrading this protocol). He did offer me a prescription for a steroid cream were I to need it, but I never did so I didn’t request it. I followed the lead of a friend of mine up in MI, who began using aloe as soon as her first treatment was done and applied it consistently twice a day. My routine was to apply Aquaphor in the changing room, and at bedtime for the first two weeks to apply first aloe or calendula and then Aquaphor. The third week I used aloe at night and Aquaphor in the changing room. I can’t say whether that was what kept my skin from breaking down, itching or hurting--pretty sure it was a combination of that, the shorter duration and narrower field (the under-bust, sternal juncture and axilla were all outside the field). I didn’t need to stop using antiperspirant because the axilla wasn’t irradiated. I had no problem with skin-to-skin contact because I never went braless except in the shower, but again that part of my breast also wasn’t irradiated. Had no skin breakdown of the crease beneath the breast nor irritation from bras (wired or not) for that same reason.

But from what I’ve been reading here, mine was a rather unusual and fortuitous situation--and I’m probably the exception to the rule.