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Radiation - concentrated dose
Clari
16 Posts
Radiation oncologist is offering the option of a 5 day course of radiation over 1 week, rather than 3 weeks/15 days. Idea is to reduce trips to the hospital given COVID. Has anyone had the concentrated doses? Impact/side effects?

I'd have partial rather than full breast either way, as tumour was Stage 1, Grade 1, clear margins. I'm leaning towards the shorter course, but wonder if anyone on here has had it.
15 Replies
Essjay
1364 Posts
Clari‍ i Know a few ladies in UK who have had the 5 doses and done very well on them. It’s a protocol that’s been used in Europe for about 5 years. My contacts had no skin issues and were very happy to have radiation over so quickly.

I find the differences between North America and Europe interesting. In USA they are still using an older protocol of 30 radiation doses over 6 weeks, whereas in Canada we shifted to a hypofractionated dose that brings the standard dose down to 16 visit (both regimes give the same number of grays overall). The new 5-day protocol is really helpful in COVID as it reduces the exposure of patients to people. Similar changes have happened for other cancers as they discover that their fears of greater tissue damage from higher doses are unfounded.

I had 20 doses (the standard 16 plus 4 boosts to the tumour bed due to poor margins), and it was tiring going every day for four weeks. If I was given the choice of 5 I would take it, based on positive experiences from my contacts.

Hope this helps, Essjay
Clari
16 Posts
Essjay‍ That's so helpful. My radiology oncologist said it was "up to me" but didn't give me much to base my decision on, even when I asked. Unusual, as I have found everyone else I've dealt with very willing to answer questions.
chrys21
63 Posts
Clari
thanks for posting this. I have my first radiation oncology appt this coming week and I’ve been wondering what might be offered. I feel stressed just thinking about having to make another “up to me” decision. I don’t think it’s okay to not be informed of any pros and cons to the new approach.
Clari
16 Posts
chrys21‍ I dug around a bit. This podcast is helpful in explaining some of the research and options in layperson's terms. As Essjay‍ says, it seems like the UK and Canada are ahead of the US on this. https://www.breastcancer.org/community/podcasts/hypofractionated-radiation-20201202 .

I will still ask my radiation oncologist about side effects of partial radiation PLUS 5 days - I think she needs to be able to explain this to patients. It sounds like partial is already an additional focussed dose at one time, and 5 days even more so. I get that there might not be complete data yet, but sharing more info is important if we're supposed to be making decisions. She did explain partial radiation quite well to me, just not the impact of the 5 days as well. For my circumstance (clear nodes and margins, small tumour, Grade 1) I think partial makes sense to reduce the damage to other cells, including lymphs and lungs. 5 day course probably also makes sense given Covid.
chrys21
63 Posts
Thanks Clari
What do you mean by partial?
Clari
16 Posts
They can give radiation to the whole breast, if they think there's a chance the cancer spread, or partial which means focussed (in my plain language understanding) - on the specific site where the tumour was itself.
S2020
11 Posts
Hi Clari.

I am going to be having the 5-day hypofractionated radiation treatments to the whole breast. I wasn’t given an option to do the longer treatment protocol.

Below are links with more information:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30932-6/fulltext

https://www.advancesradonc.org/article/S2452-1094(20)30149-4/pdf

I am glad Essjay posted a response about five women she knew who had this treatment.

Have you had the radiation planning CT yet?
County Girl
19 Posts
Clari‍ i had the shorter radiation treatments. 4 normal and 5 high doses in December 2020. I’m Triple Negative stage 2, grade 3. I had lumpectomy with clear margins and one lymph node had small cancer cells. The Radiation Oncologist stated since Covid, Canada was following UK’s model of radiation treatments. It seems that the outcomes are the same as longer treatments with much less side effects and time commitments. I live 5 hours from the closest radiation treatment centre so I was very happy to only spend 2 weeks away from home. I had no side effects or redness. I was a little tender for a couple of days but it went away quickly. Hope this helps. Good luck with treatments.
JustJan
327 Posts
I was given the option of doing 25 or 16 rounds of radiation. Radiation Oncologist said there was no difference in efficacy between the two. Since I drive 45 minutes each way to treatment, I chose 16. If I was given the option of 5 and oncologist was confident, I would have chosen 5. Sounds like this could become a new standard of practice. Wouldn’t it be great if Covid actually caused a change that has a positive impact on treatment for breast cancer? It would also mean being able to treat more people in a timely fashion.

Sometimes necessity is truly the mother of invention!

Clari
16 Posts
S2020 Thanks everyone. I'm having the scan/plan session shortly, at which time I'm to tell the doctor what I prefer. Helpful to have your input. If I can do the shorter course safely, I agree that's great, especially given COVID.
BookLover
13 Posts
Thanks for your very timely and informative posts. I will be having the 5 treatment protocol on an enlarged lymph node in the very near future. My "mapping" CT scan is on Tuesday and reading the information here has helped me a lot.

I have ovarian cancer and they don't typically use radiation as a treatment for it but because it's a single node it was decided to try it and save chemo for when my organs are involved.

Thanks again!
CCC888
73 Posts
Thanks for creating the topic. Interesting topic.
My MIL received her Accelerated partial breast irradiation (APBI) from CTCA in U.S. last year for her stage 1, no lymph node involved breast cancer. She had no skin issue and barely any side effects. I am wondering if APBI is the same as the 5 days concentrated dose radiation. Like Essjay has mentioned , USA is still using 3/4 weeks EBRT for whole breast (maybe as well, near lymph node , collar bone) radiation.

https://www.cancercenter.com/cancer-types/breast-cancer/treatments/radiation-therapy
elle29
137 Posts
Clari Hi I am Elle 29 I saw a study was being done on this at UK cancer web .I he u asked wil it be necessary in your survival rate or stop any future spread with followup . And is there still a chance of getting cancer having radiation I read .
Naan
34 Posts
I have metastatic breast cancer. I didn’t have radiation for my initial breast cancer treatment but on my head for a brain tumour that was removed in March of 2020 and then again in October for spot on my left lung. I had 5 doses each time with no issue. I have a small rash on my back from the lung radiation which is just itchy.
Treepeo
239 Posts
Hi Clari‍,

I had 15 radiation treatments and ended up badly burned. The first two weeks I was fine, but the last week did me in. So if I were you, I would have the 5 treatments and see what happens. I hope you are one of the lucky ones that doesn't suffer burns from radiation. Fingers crossed.
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