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brachytherapy vs whole breast radiation

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dmwolf View Drop Down
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    Posted: Oct 24 2012 at 5:28pm
Hi, folks.  Some new research came out suggesting that brachytherapy might be associated with a greater risk of local recurrence and higher rate of complications (leading to worse cosmetic result).  It is also more expensive than regular radiation.  So if you are at the point in your treatment where you are deciding how to proceed, you might want to lean toward whole breast radiation with boost.

I'll get you the references soon.

Best,
d

DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.
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Lillie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lillie Quote  Post ReplyReply Direct Link To This Post Posted: Oct 24 2012 at 9:55pm
Thanks Denise,
 
I talked with a lady last week who recently had brachytherapy.  She was excited that it was fast and less side effects.  I had read about this a few months ago but had not met anyone that actually had it.  I will be interested to see how she fares.
Thank you for keeping us up-to-date on the newer procedures.
 
Thanks,
Lillie


Edited by Lillie - Oct 25 2012 at 10:41am
Dx 6/06 age 65,IDC-TNBC
Stage IIb,Gr3,2cm,BRCA-
6/06 L/Mast/w/SNB,1of3 Nodes+
6/06 Axl. 9 nodes-
8/8 thru 11/15 Chemo (Clin-Trial) DD A/Cx4 -- DD taxol+gemzar x4
No Rads.
No RECON - 11/2018-12 yrs NED
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Oct 24 2012 at 11:33pm
Denise,

Thanks for posting this important information.  TNBC is so aggressive we need to choose the best treatment plan.  Your info will help our members if they are getting radiation.

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Oct 25 2012 at 11:20am
I saw this article today:

Summary:  The team found that the use of brachytherapy was associated with a 16.9% higher rate of wound and skin complications in the year after treatment compared to whole breast irradiation. There was no significant difference in the rate of deep tissue or bone complications between the two treatments. 

"This study highlights the importance of conducting comparative effectiveness research before a new treatment becomes widespread," said Gross, who is co-director of the Robert Wood Johnson Clinical Scholars Program at Yale. "Medicare is spending significantly more money to cover this treatment, which potentially exposes women to a higher risk of complications than the 'tried and true' whole breast irradiation." 

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Carol3 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Carol3 Quote  Post ReplyReply Direct Link To This Post Posted: Oct 25 2012 at 2:15pm
All,
 
When I was making this decision, my doctor would not recommend brachytherapy as it was to new and the research has not been proven specific to TNBC. She specifically stated TNBC is to agressive and this would be to high of a risk. She would only do whole breast radiation.
 
Just my experience.
 
Carol
DX 3/25/11 TNBC Stage IIa, grade 3, Tumor 2.3, chemo started 4/22/11. 12 Taxol/4 Charboplatin 4 AC. iSpy2 Trial. Parp Inhibitor ABT-888. BRCA1/2 neg. 20 Rads. 0/2 nodes. Finished 11/23/2011
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ann u View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ann u Quote  Post ReplyReply Direct Link To This Post Posted: Oct 25 2012 at 5:13pm

I had Mammosite radiation - a form of brachytherapy - 6 years ago.  My radiation oncologist made sure I matched the strict guidelines of being able to pursue this (small tumor, clean margins, location, etc).  With this radiation, you do it shortly after your lumpectomy, and before chemo.

My radiation oncologist inserted the catheter tube into the tumor cavity left from surgery.  I did one week of radiation 2x day, six hours apart, for one week.  Before each "zap", I was given a quick CT scan to make sure the balloon catheter was in the correct place.  After the last session, he removed the catheter.  I started chemo two weeks later.
 
I had a very rare complication after I received my first chemo. I had what was called a "radiation recall" at the surgery/radiation site that became slightly inflamed, but was treated with antibiotics as a precaution.  I still, six years later, have scar tissue in the area, but I am used to it being there.  I scar easily anyway, so this is probably just me and not the norm.
 
My second TNBC diagnosis was not at the original site.  I had a double mastectomy that time, and my PS had no issue with the radiated area in my axilla area.  It did not interfere with my reconstruction at all.
 
I still am happy that I was able to do this type of radiation.  It was quick (one week vs. 6 weeks), and it was less costly for me ($125 in co-pays vs. appoximately $900 for regular whole breast radiation).  There are good points and bad points to every procedure you have to choose.  You make the best choice with the information you have at the time.
 
Ann
8/06: IDC 1cm, 0/9 lymph nodes, lumpectomy, Mammosite radiation, 4 x A/C
5/07: BRCA1+ (5382insC)
11/09: IDC 3mm, double mastectomy w/reconstruction

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