Advice please “Canadian” (21 days) or “American” (31 days)

Good morning. I did 21 days after three very respected hospitals said it was just as effective with fewer side effects. It worked out great for me and of course it is way more convenient. I'd definitely recommend it.

If I understand things correctly from my doctor, the protocol of using less treatment days (but with an equal total amount of radiation) has been in use for at least a year or so in Europe. Maybe that can help you in making a decision?

I was told I could do the shorter method and was so happy. Then found out the RO changed her mind - cue the devastation. When I asked why she said not because the “Canadian” method was less affective at destroying cancer cells, but because the cosmetic repercussions for years out are unknown. So being I’m young and had a lumpectomy she thought this was a good idea. Maybe it doesn’t make sense, but at the time I wasjust like “whatever”.

There is a new radiation protocol for "hypo fractionated" radiation, which increases the radiation dosage per visit, but decreases the number of days for treatment. As far as I can tell it has nothing to do with Canada or the United States. As I understand it, radiation doses are measure in "grays," with a customary treatment plan calling for 2 grays of radiation per visit. However, by increasing the grays, the number of visits decreases. For example, I had 21 radiation treatments - the first 16 were whole breast @ 2.66 grays per session. The final 5 were boosts, @ 2.20 per session. But it's not for everyone. Hope this helps. Here is the citation:

http://www.breastcancer.org/research-news/accelerated-whole-breast-radiation-new-standard

I think that hypo fractionated protocol and 21 day 'Canadian' protocol are the same. I will be having 21 days , 15 to whole breast and 5 day boost to cavity. My RO told me that this was becoming more of the standard of care lately and he is preferring it because research is showing that it is just as effective as 31 day treatment. My radiation therapist actually told me that me that women who have 21 day treatment tend to have fewer skin issues.

Hi Amelia - re hypofractionated radiation not being for everyone, I was making a general statement based on my perception of the article. My takeaways were: accelerated radiation worked as well as longer courses; is available to a much larger group than the previous guidelines it replaces; but was still on a case by case basis. An example given in the article is:

"These guidelines apply to most women diagnosed with breast cancer," said Marisa Weiss, M.D., Breastcancer.org chief medical officer and radiation oncologist. "There are some exceptions, however. The ability to deliver a larger daily dose requires that your doctor design a radiation treatment plan that is very even throughout the whole area of the breast. Sometimes this is hard to achieve. In women with very large breasts or who have a large chest size, it may be hard to achieve an even dose, so your doctor may recommend a traditional dose schedule of 5 to 7 weeks.

"It is important for each person to get the best care possible for her unique situation," she continued. "The hypofractionated schedule is likely more convenient and less disruptive in your busy life. Still, if you have to have a longer treatment plan, don't think that this means you have a worse situation or worse outcome. These guidelines have no impact on prognosis or how well you do."

Searched for 21 day rads with boosts and found this thread. Thanks ladies who contributed. It was very helpful.

I will be starting the 21 day rads to include 5 boosts on Monday. Glad to be moving forward with this phase of treatment.

Best wishes to everybody else.