Canadian protocol, need help deciding on boost treatments

jdot, I too opted for the Canadian protocol (hypofractionated) and will start this week (March 10, 2016). I'll be receiving the boost as well. I tried to do my research, but there are many differing opinions regarding the hypofractionated course of treatment vs the longer conventional course- especially with grade 3 tumors, as mine was. I'm doing what seems best to me, just made peace with my decision and am moving forward! Almost looking forward to getting started, just so I can get through it and be done with that step! One day we will put this all behind us, right?

When will you start your RADS?

Tumor size was 8mm - small but aggressive! Oncotype score 21 - intermediate risk of recurrence, what my RO described as a 'gray area'.

Wow, that will be a commute for you. That didn't factor into my decision, since my treatment facility is about 3 miles from my house - I'm very fortunate in that respect.

My RO gave me the choice but I could tell he favored the shorter treatment. He said if his wife had to make the decision, he would favor her choosing that. He made it clear that he would be fine with whatever I decided, but you're right, its scary when its left up to us! I read a lot of scientific studies and had to brush up on my college statistics classes! And still there were more gray areas. My patient navigator asked me, "If you do have a recurrence years down the road, will you be able to look back and say, 'I made the best decision for myself with the information I had at the time, and I'm at peace with that'? I pondered that for awhile and decided I'd be able to say just that. Decision made.

Know that I'll be thinking about you on Thursday, as we start this part of our journey together!

I had a third protocol: 16 treatments, double-dose, all to just the tumor bed. My RO had just finished participating in a trial that found identical results with that, the Canadian protocol (16+5 boosts), and the standard 33-treatment protocol in women >60, with node-negative luminal A tumors <2cm. (I was 64, had node-negative luminal A, 1.3cm). The protocol I had produced less fatigue and fewer skin side effects than the other two (although I did get enlargement of my tumor-cavity seroma and fibrosis between it and the skin).

hi jdot, I had the Canadian protocol 16+5. I was very afraid of the boost and made my decision to go ahead with it for two reasons. One of my margins was less than 1 cm and I wanted to make sure I did everything possible to keep the cancer from coming back. No guarantees about this, but I didn't want to live with any regrets either. I did really well with radiation treatments and they fly by once you start.

And then there is my protocol...also a clinical trial. I had 10 treatments, 2x a day for 5 days of partial breast rads. Where the standard protocol is whole breast (as is the Canadian) with boosts, mine was in essence just boosts and in the end, it was less radiation and I suffered little to no ill effects (save for fatigue) during and right after I was finished. Now, several years later, I have some fibrosis and shrinkage (quite a bit actually) and am still okay with my choice because I got in and out quickly. As long as it works in the end, I am good with it even though cosmetically it did not work as well as they had hoped. I am way past my age of caring (will be 61) of what my breast looks like without clothes on as it beats having to have a MX (for me as my bc was small) so am good with it.

Welcome, jnu. We're sorry for what brought you here but glad to have you join us.

First of all, radiation is never done until one has healed from surgery. That's anywhere from 4 wks-2 mos. Radiation isn't just like having an x-ray, its effects are cumulative and real injury can be done to tissues that have yet to heal sufficiently. I had to delay mine due not just because of waiting for my genetic test results (which had they turned out differently might have made bmx advisable instead), but also to the SNB incision rupturing and the seroma beneath it leaking (explosively at first). It had to be sutured, the sutures needed to stay in two weeks and that needed an add'l week to heal. Second, acc. to my RO, the women who are considered old enough to skip rads are generally 70 or even 75+. My ex-office mgr (she & I share the same PCP and MO) was able to skip it--but she's 81. Being over 60 (64 at the time) made me eligible for the partial-breast double-dose 16-treatment protocol--it didn't exempt me from rads as the std. of care.

Nobody can force you to do or skip anything. But before you make a decision you might regret later on, you need to discuss this thoroughly with your RO, asking him every question that comes to mind.

Oh, and if you fill out your profile and make it “public," we might be better able to effectively address your concerns.

Sorry I focused on your reference to some older women not needing radiation, when your question was actually about boosts. My bad.

jdot:

Discussed dilemma with RO at appointment today. It was decided that we would add 1 additional whole breast radiation for a total of 16 and forego any boost. He indicated that since my tumor was small and ocotype was 13 indicating low recurrence, there was no reason to undergo the additional radiation. We discussed the clinical study which was the subject of the article that you referenced on Medscape. It actually fit all my criteria. Thank you. My last radiation will be March 17, 2016 (the luck of the Irish) and I will start hormonal therapy on March 18, 2016 (the beginning of a long road). Wish you luck and will check back.

I posted this morning after my appointment, but forgot to hit submit

I had no discomfort after the first treatment. I have been using Cetaphil moisturizing cream which was one of the cream recommended. Using it after radiation, in the evening and before bed. After my 11th treatment my breast is blush to red and I am experiencing discomfort in my sternum and ribs. I would mention your feeling of heat discomfort since this was only your first treatment.

Hi jnu3. My stats are similar to yours, except my Oncotype score was 21 and my tumor was grade 3. I opted for the boost mainly for those two reasons - grade 3 tumors showed a slightly higher recurrence rate with the HF protocol in one study where a boost wasn't given. So many things to consider; we just have to make peace with our decisions and not second guess ourselves. I wish you the best, and I'm glad you came to a decision that you're comfortable with!

Anyone else experienced this? I got a call this morning from my RO office - I was told not to eat or drink anything for 4 hours before each treatment from here on out. Apparently yesterday, at my first treatment, my stomach was too close to the radiation field and it needs to be as empty and small as possible so it's not affected. What??? I don't have a big stomach - I'm 5'2" and 115 pounds. My treatments are 2pm each day...so no lunch for me I guess.

Well, RO added one additional whole breast treatment and no boost. Today was number 16 and done. Still will have the redness continue for a little while longer - I guess its like cooking in a microwave that when the timer goes off it still cooks a little longer. Now to the aromatase inhibitors.