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Is 6-1/2 weeks standard protocol?

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Radnam View Drop Down
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    Posted: May 07 2021 at 4:15pm
Hello,

My wife is 48. Went through neo-adjuvant chemo (4 AC + 12 TC), including immunotherapy (Keytruda), for her TNBC treatment. We got RCR (Radiological complete response)!!! Woohoo! 

Followed by lumpectomy and biopsy came back with PCR (Pathologic complete response). WooHooooooo!

Now we have to start radiation. Met RO today and he has recommended 33 treatments, that include 5 boosters at the end. For some reason, we were expecting 20. And this seems excessive.

Can someone please confirm if 33 treatments is standard and necessary? 

Thanks in advance.
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Vivian View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Vivian Quote  Post ReplyReply Direct Link To This Post Posted: May 08 2021 at 1:03am
Hello Radnam, congratulations on the RCR and PCR! This is the best news we can hope for from the moment we got the devastating diagnosis.

I had the same treatment sequence and same results as your wife's (cCR and PCR). My radiation oncologist gave me 20 times radiation. I didn’t know if this was the protocol. In addition to the many times, the dose also matters (the strength of the radiation energy). 

I read on this forum people could get different number of radiation sessions for different medical specifics. You can tell the doctor your concerns and ask questions. Every step is critical in cancer treatment; you should feel informed and confident about the plan.

Your wife is near the end of the tunnel. Hang in there and she will soon feel anew. 

Best,

Vivian



Edited by Vivian - May 08 2021 at 6:50pm
Dx 12-27-2019 TN,Stg 1, Grade 3 Ultrasound 1.5cm/MRI 1.8cm, node-,BRAC-.
DD AC x 4, ultrasound cCR;
DD T x 4
Lumpectomy:5-28-2020; 0/2 nodes. pCR.
Radiation: 20x
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CMDW View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CMDW Quote  Post ReplyReply Direct Link To This Post Posted: May 08 2021 at 5:20pm
My situation is similar to your wife’s.  I was 66 at diagnosis (3/19) and also achieved complete pathological response after ACT chemo and lumpectomy.  Still, it was recommended that I have 30 rounds of radiation-25 + 5 booster.  I did not question this.  I am one year and five months out from completion of radiation treatment-so far so good.

I will say that for me, radiation was not so bad other than the inconvenience and continued fatigue.

 Best wishes to your wife and you!  Cindy
66 at diagnosis. 3/2019, AC/T, lumpectomy, 30 radiation. Complete 12/19. IDC, grade 2-3, 4 cores .2-1.5cm, yellow lobulated fibroadipose, stage pT1b, NO
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Plume Quote  Post ReplyReply Direct Link To This Post Posted: May 09 2021 at 6:21am
Hi Radnam

As you can see, I am from France but I also had 33 lots of rads with 8 boosters to the "bed of the tumour".  The specialist said that he could do it with just 20 sessions but that it was better to have more sessions but lower doses so as to minimise the side effects such as skin burns. 

I hope you find my experience useful.  In any case, all the very best for Mrs RadnamSmile
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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: May 11 2021 at 8:15am

The research was published in the May 23, 2020, issue of The Lancet. Read “Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial.”

Hypofractionated vs. traditional radiation therapy

In March 2018, the American Society for Radiation Oncology released updated guidelines on whole-breast radiation therapy saying that most people diagnosed with breast cancer should be treated with a hypofractionated radiation schedule.

In many cases, people diagnosed with early-stage breast cancer have radiation therapy after surgery to remove the cancer. Radiation therapy lowers the risk of the cancer coming back (recurrence).

Whole-breast radiation therapy after breast cancer surgery is usually given as one treatment per day, 5 days a week, for 5 to 7 weeks. A Gray (Gy) is the way radiation oncologists measure the dose of radiation therapy; if you’re on a 5-week treatment schedule, 50 Gy is the usual amount given during the 5 weeks (2 Gy at each treatment). A supplemental “boost” dose may be included at the end of the regimen that targets the area where the cancer was.

Radiation treatment schedules were developed based on research results. But a 5- to 7-week nearly daily commitment may be difficult for some people, especially if they live far away from a treatment center. So doctors developed and studied different radiation therapy schedules that involve fewer treatments with higher doses of radiation at each treatment, but about the same total radiation dose. These hypofractionated radiation schedules put the same radiation dose into a 3- to 5-week schedule, instead of a 5- to 7-week schedule.

A hypofractionated whole-breast radiation schedule is appealing to doctors and people getting radiation therapy for several reasons:

  • Convenience: arranging daily trips to get treatment can be a problem for some women, and fewer treatment days or a shorter period of time may be easier to schedule.
  • Compliance: if radiation is more convenient to schedule, women may be more likely to get all of their recommended radiation therapy.

But a 3- to 5-week daily commitment to treatment can still be difficult for some people to complete. So researchers have been studying if even shorter radiation therapy schedules can be as effective as the longer schedules.

https://www.breastcancer.org/research-news/accelerated-rads-has-same-effect-as-traditional

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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