Partial Breasst Radiation

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dazedandconfused123
dazedandconfused123 Member Posts: 61
edited January 2016 in Radiation Therapy - Before, During, and After

I am still wondering if I may be eligible for partial breast radiation. On my last consult with my radiation oncologist, she recommended full breast radiation for 3 weeks. Her concerns were that I had a .6mm IDC, grade 3, which had not shown up in earlier testing / imaging. Her words were that it was "sneaky" and tended to "hide". Since then I have consulted with Dr. Michael Lagios and have a call into Dr. Robert Kuske's office. In addition, my Oncotype score on the IDC came back 9. For reference, my On Oncotype for my DCIS in 1/15 was 15.

My lumpectomy was 11/24/15 so I am not sure if am even eligible for SAVI or Mammosite given that my cavity has probably healed by now. Almost all of the swelling has gone done by now.

Kuske's office offers something called Multiple Catheter (Interstitial) Brachytherapy which I may be eligible for.

Questions:

1. Would I be eligible for SAVI or Mammosite so much time after my lumpectomy?

2. Is anyone familiar with the Multiple Catheter (Interstitial) brachytherapy? Would I possibly be eligible for this type so much time after my lumpectomy?

3. Does the low Oncotype score have any bearing on the radiation decision? I am wondering since it came back low the radiation oncologist may reconsider.

Thanks everyone!

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  • dazedandconfused123
    dazedandconfused123 Member Posts: 61
    edited January 2016

    Bump - anyone??

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  • BrooksideVT
    BrooksideVT Member Posts: 2,211
    edited January 2016

    I don't think the RO will be impressed with your oncotype (sorry!).

    1. The RO is concerned only with local recurrence and it is his or her job to evaluate and treat your breast and only your breast. Hopefully he or she has already shared the studies with you that show the large difference in recurrence (both local and distant) between those who received rads and those who did not? If not, do ask for this information so you can make an educated decision.

    2. The oncotype is a predictor of distant recurrence. In other words, it addresses your risk of mets to your bones, lungs, liver, and brain, plus the occasional other site (not the RO's territory at this time, although rads can later be used to treat mets). Your oncotype score assumes that you have had either a mastectomy or a lumpectomy plus rads, and assumes moreover that you will take tamoxifen for five years. If you do not have radiation, or do not take tamoxifen (or an AI), its predictive value is questionable at best.

    Here's one article that might be somewhat helpful, although it is valid only for pure DCIS; IDC would probably increase the risk.

    http://www.breastcancer.org/research-news/20131004

    I realize you are very interested in having only part of your breast receive radiation. Or parts? I think you might have mentioned more than one site? Rather than exploring invasive (ouchy) techniques, perhaps you could ask your RO about directing the beam only to those specific areas? I think you'd actually have less chance of scatter, and less chance of skin issues/discomfort with a more traditional approach.



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  • Sydneyluv
    Sydneyluv Member Posts: 26
    edited January 2016

    Dear Dazed, This is a very confusing time for sure. At my cancer center in Michigan, you would not be eligible for any form of partial breast radiation related to your youngish age and the fact that the surgery site would be sealed up and getting into it would not work. Putting the radiation appliance into the lumpectomy cavity is how the treatment works. As far as I understand it, it needs to be done within a month of surgery and usually much sooner. At my center and in most studies, the cut off age for this form of radiation therapy is over 60 or 65.

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  • dazedandconfused123
    dazedandconfused123 Member Posts: 61
    edited January 2016

    Thanks BrooksideVT! I definitely plan to have radiation...just hoping that I could qualify for partial. No I only have the one area to be radiated...not more than 1 part:) But that is an excellent idea to inquire about directing the beam to certain areas. I do hope to skip Tamoxifen as well.

    Thank you also for the detailed explanation of the Oncotype score.

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  • dazedandconfused123
    dazedandconfused123 Member Posts: 61
    edited January 2016

    Thanks SydneyLuv! It is confusing. I have heard that about the cutoff age.

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