• Regular or accelerated radiation?

    Asked by Lorie on Saturday, April 18, 2015

    Regular or accelerated radiation?

    The posts on this subject are over 2 yrs old. Was wondering if anyone had the accelerated type (3 wks larger dose) recently? The local radiation onc said he only gave it once but the radiation onc at the finest cancer institute I go to said it is just as effective and has fewer side effects. Thanks for any info and cyber well wishes to all who have to be here.

    22 Answers from the Community

    22 answers
    • Penny82's Avatar
      Penny82

      Different radiation oncologists feel differently about accelerated vs not. One oncologist I worked for would do 300cGy per day for 10 days. The other wouldn't do more than 250cGy. In Canada, I have been told, they do 1 day of 800cGy for bone pain. It is supposed to be really effective but one day later the pain is excruciating before it goes away. I have never treated a breast accelerated like that. I am interested in what your daily dose and total dose would be.
      As far as having fewer side effects you should ask if it is fewer side effects all around or fewer side effects while under treatment. Radiation reactions happen at a certain dose and can take a few days to present themselves. Which is why radiation burn gets worse before it gets better. With accelerated treatment you may be done before experiencing the worst of it. But I am very curious. If you do have accelerated treatment would you please blog about it or let me know how it goes. Good luck and best wishes with your treatment.

      over 3 years ago
    • lujos' Avatar
      lujos

      I'd be interested in answers to this too. A friend here in Spain is having higher dose for 15 days, for some reason -- I live an hour and a half from the hospital, so the shorter course is attractive to me for obvious reasons! However, I have very pale, delicate skin, large breasts, tumour area on he breast under side, so not sure the increased rad would be good for me.

      over 3 years ago
    • kghalva's Avatar
      kghalva

      my rad onc would not do the accelerated because he said there weren't conclusive studies showing it was as effective, with Her2 positive breast cancer. So even tho I live 1 3/4 hour away from the facility, I had to do the 33 days. My last day was Friday!!!! However, a friend of mine had an accelerated 21 day treatment at a different center - she was Her2 positive too. BUT she had really bad radiation burns, which lasted for weeks and weeks after she was finished. She has large breasts, and her tumor was on the underside, too, like yours. My burns have been much milder than hers. But who knows, since different people react differently! If you like and trust your radiation oncologist, I'd do whatever he recommends, I guess.

      over 3 years ago
    • lujos' Avatar
      lujos

      Thanks for that info, kghalva, I would rather go for more trips and avoid the bad burns if possible! I did wonder if the higher dose would make it a whole lot worse...

      over 3 years ago
    • Penny82's Avatar
      Penny82

      kghalva- those would be the side effects I would expect to see. The way the radiation works is that it damages the cells healthy and cancer cells. The healthy ones can repair but the bad ones die off. The smaller dose is prescribed over a longer period so the healthy ones can repair daily resulting in a burn but tolerable and moderate. If the daily dose is too much, more of the healthy cells will die and not be able to repair themselves as quickly resulting in a much worse burn which in turn takes longer to heal. And this is why I question that the doctor said less side effects, unless he is planning on treating with a different type of radiation, maybe internal, in that case it is true. But either way I am very curious because I have never treated accelerated and wonder how it differs.

      over 3 years ago
    • lujos' Avatar
      lujos

      Penny82, any opinion on IGRT or IMRT re side effects and effectiveness? I see the radiation oncologist in a few weeks...

      over 3 years ago
    • Lorie's Avatar
      Lorie

      Thank you all for the answers.
      Penny82 ..at the time the onc at the state's best cancer hospital said less side effects with accelerated rad, he was not referring to internal rad. I had two lumpectomies because of specks near the margins of the first one and he said whole breast rad was recommended. I am going to email him and ask for sources to read that supports his theory of less side effects. I am HER2 neg.
      Lugos You just asked about IGRT and IMRT which is greek to me at this point. Should I look into the different kinds of normal rad before I see the local rad doc here Tuesday?
      Kghalva, congrats on the completion of rad. That was 33 days of a lot of miles. The specialty center where the onc is who recommended accelerated is over an hour away from me so I was seriously considering the one more local.

      over 3 years ago
    • Penny82's Avatar
      Penny82

      IGRT stands for image guided and IMRT stands for intensity modulated radiation therapy. They can be used together. For breast treatment IMRT hasn't been proven one way or the other. IMRT is very good for avoiding sensitive structures for example treating uterus while avoiding bowel and bladder. Maximum dose can be delivered to the uterus while minimizing dose to other structures which helps with side effects. IGRT is useful for those types of treatment as well because a tighter margin means less dose to other sensitive structures. With breast radiation there are not sensitive structures within the treated volume. A sliver of lung is always treated to get nodes along the chest wall and the heart is blocked with the mlc leaves or a manual block. IGRT does give more radiation since you get an xray everyday. It is a minimal dose, especially compared to the treatment dose you get. I know some insurances don't pay for IMRT and for breast treatment it is not worth paying out of pocket.

      over 3 years ago
    • msesq's Avatar
      msesq

      I started hypo fractionated radiation for my breast cancer in December 2014 and ended New Year's Eve 2014. I live in the Northeast and although my treatment center is close I have to drive over a mountain to get to it so I choose the faster radiation, double the dose for 16 vs. 32 sessions. I was afraid the side effects would also be double but was very pleased I only got a mild sun burn on the area radiated. I did extensive research and the method has been used in Canada and Europe for 20+ years. Statistically the outcome is the same according to my research. Only your radiologist can tell you if you are a candidate for this type radiation. I am Stage 1, HERS2 +, IDC and DCIS. Tumor was 2.5 cm but to get clean margins removed 7cm to get the DCIS.

      over 3 years ago
    • CAL's Avatar
      CAL

      I investigated the accelerated type back in early 2013. I had IDC stage 2B so radiation was recommended after my large lumpectomy and chemo. My radiation oncologist thought it could be just as effective as the 34 treatments but was concerned because I am very fair complected with dry skin and very large breasted. He was concerned that to get a high enough dose to be effective, I would have significant burning which might make me have to stop treatment. Since the only place where it was available to me was 3.5 hour drive away from my home, I decided to go with the usual treatment. The difference was that because of the location of the tumors and the fact that I am so large breasted, the treatments were done while I was on my stomach and that helped to avoid a lot of the side effects on internal organs. I still got some burning but not until close to the end of my 34 treatments.

      over 3 years ago
    • lujos' Avatar
      lujos

      CAL, I'm IDC 2b as well, so thanks for your experiences. I had looked at having rads in prone position, but as my tumour was in the underside of my breast, not sure it would be possible?

      over 3 years ago
    • Lorie's Avatar
      Lorie

      CAL. Mine on underside so wonder where yours was??

      over 3 years ago
    • patches450's Avatar
      patches450

      I had accelerated radiation at a very prestigious cancer center for IDC last June-July. I had 19 treatments vs 35 as is the protocol in my area hospital. they said that they have followed that protocol for the past 8 years and, as you were told, that outcomes are the same or better than the longer course and usual complications are less, Not everyone is a candidate for the accelerated plan so each is evaluated individually.
      I was able to stay with a family member who lives near that facility so it was an easy decision for me,
      The treatments were well tolerated with minimal skin redness and that was for the last few altho it did continue for a while after the end of therapy, I should say that I am very fair skinned. They have you do extremely deep breaths and hold for the few seconds the beam is active, that retracts the heart altho there was some radiation to the upper tip of my left lung as they treated the supraclavicular lymph nodes since I had 9 of 21 axillary nodes positive. That can not be avoided at least in my case. There is every attempt to avoid radiation to the heart. The main complication I am aware of so far is lymphedema in my breast on that side, It is most likely the result of the radiation since it set in about 2 months after the treatments were completed. As a result I have to wear compression garments and have learned to do lymphatic drainage massage. These practices have kept it at a stable level. I don't know if it will ever resolve, I have no way of knowing if the longer treatment plan would have made any difference, so I can't say I would have made a different choice. This is not something that happens to everyone, I was told about a 20% chance of it.
      I hope this helps you. If you have any questions feel free to follow up.

      over 3 years ago
    • msesq's Avatar
      msesq

      Patches450, your lymphodema is more likely due to the removal of your lymph nodes than the radiation. I had two lymph nodes removed had the accelerated radiation and knock on wood haven't had any lymphodema. I do wear a compression garment when I fly as my surgeon said it could develope anytime in the future even 20 years from now.

      over 3 years ago
    • marybeth's Avatar
      marybeth

      It was two years back for me, but I did 20 rounds of radiation and experienced no negative side effects other than some itchiness. A friend of mine just finished same. She did develop a pretty bad burn on that side but two weeks later is doing fine. I know it is more the norm than the aberration in Europe, largely because it saves time and money and, as far as the research goes, has the same beneficial impacts and no additional negative consequences for most people. I remember my radiation onc. telling me that I was a good candidate partly because my breasts are on the smaller side but don't know what this might actually have to do with anything. Ultimately, my friend who just finished up with it has large breasts.

      over 3 years ago
    • Lorie's Avatar
      Lorie

      Here's a site I found about it. Apparently they also call it hypofractionated. Sounds like good results and am also encouraged by the posts of you who have had it and reported good results. Thank you. Now I just am leery about the local rad practice that is not that familiar with it. Looks like local rad onc and I will have a good Q&A session Tuesday:):)
      http://www.ncbi.nlm.nih.gov/pubmed/24267970

      over 3 years ago
    • Penny82's Avatar
      Penny82

      Don't worry about the actual set up of your radiation treatment, even though I have never seen it, I would be able to treat it because the setup is the same. Same holds true for that radiation site as well. The only thing that would be different would be your daily amount. The radiation oncologist will be able to prescribe it because there are already existing protocols (the exact amount and dose proven to work).

      over 3 years ago
    • Penny82's Avatar
      Penny82

      What an interesting article. The lack of side effects make more sense. The total dose is around 4000cGy vs 5000cGy, and 4000cGy is usually when skin starts breaking down. That sounds very good for patients and it is comparable to the traditional treatment in terms of effectiveness. Thank you for sharing.

      over 3 years ago
    • CAL's Avatar
      CAL

      Lujos and Lorie--I had two tumors approximately 1 inch above the nipple and at least 1 inch deep into the breast. It took a bit of positioning and measurements but it was a good location in terms of the prone position for radiation.

      over 3 years ago
    • Lorie's Avatar
      Lorie

      Thank you all. Starting accelerated treatment Wed. Will keep you informed if you like.
      Penny I don't follow the references to the 4000cGy vs. 5000. Don't know what this is and didn't see it in the article I posted the link to. Can you enlighten me:)??
      The radiologist said he used it once on a large breasted woman and she had hardness and would not do it on me if I was big....but I'm not and he said a perfect candidate.

      over 3 years ago
    • Penny82's Avatar
      Penny82

      Lorie, Gy (gray) or cGy (centigray) is the unit of measurement used when prescribing radiation, like how milligrams are used for pills. Normal breast radiation is usually to 5000cGy (50Gy) with a tumor bed boost. This treatment is saying it is a 3900cGy (39Gy) treatment with a tumor bed boost. The units are kind of hard for the layperson to understand because there isn't a frame of reference so don't worry if you don't understand the unit. Every organ, including skin, has a different tolerance for radiation. Skin's tolerance is usually around 4000cGy before it starts breaking down and having a reaction. (Everyone is different so some may have it sooner or later). So to have curative treatment before the skin starts breaking down too much is great!

      over 3 years ago
    • Lorie's Avatar
      Lorie

      Penny82,
      I follow the logic in what you said but am confused because the accelerated as explained to me is higher doses for a shorter time. Are the measurements you wrote above for each treatment or the sum of what is given at the final session?
      Lorie

      over 3 years ago

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