Radiation Update

I am getting close to being done with radiation.  As a reminder, I am having radiation because I had a lumpectomy and that is the standard treatment if you have a lumpectomy.  I was lucky enough that the cancer was not in my lymph nodes so I only have radiation in two positions (vs three if my nodes were involved).

The actual radiation treatment is about twenty one seconds in each position, so about 42 seconds total.  Yep, that quick.  I dont know the details behind it but I do know there is a physics department that reviewed my case prior to starting.  And the seconds may be off a little cause that is just me counting once I hear the noise that the radiation has started.  The technicians did say that they do not do individual treatments longer than a minute.  I know some other people with different cancers get up to 7 positions but fewer seconds in each position.

I go through a lot to get those 42 seconds of treatment . . . the radiation oncology facility is an hour away from my home or work.  That is a round trip of 2 hours.  There is a shuttle going from my local Kaiser facility to the Kaiser in Ontario.  The shuttle bus is more fun that I thought it would be.  The people on there definitely make an unfortunate situation bearable and sometimes a lot of fun.  Radiation is 5 days a week and there are people with all different types of cancer on the shuttle bus.   I notice a difference in the number of radiation treatments and the type of cancer.  So far on the shuttle people with Prostate cancer seem to have the most with 38 treatments (and 7 positions) and Lymphomas seem to have about 15-18.  There is a wide range for Breast Cancer . . . some of us have 31, while others have about 15.  I know I was given the choice of doing it in 31 or 20, and there seems to be a difference if you had a lumpectomy or a mastectomy.  One thing I have learned through all of this is that the doctors develop a personalized treatment plan, which is why there is such a difference in the treatments.

I mentioned above that I had the choice of doing my treatment in 31 or 20 treatments.  The 31 treatments are not all the same - 25 are whole breast radiation and 6 are boosts that are targeted at the scar area (or in my case area where the tumor was removed since I have scars in a different area since I had a reduction too).  It is a similar case for the 20 treatments - 16 are whole breast radiation and 4 are boosts.  In the 20 treatment plan, also called Hypofractionated,  each radiation treatment has more radiation per treatment but less overall radiation.   The 31 treatment plan, also called standard treatment plan, has a total of 50 Greys (Gy) of radiation at 2Gy/ whole breast treatment (not including the 6 boosts).  The 20 radiation plan has a total of 42.5 Gy of radiation at 2.66Gy/ whole breast treatment (not including the 4 boosts).  I asked the doctor if there were any studies done on this and he gave me the link to this study from the New England Journal of Medicine.  I read the article carefully and debated a lot on which one to do and decided on the 31 treatment plan (25 whole breast + 6 boosts) because in the aforementioned study there was a significant difference in the local recurrence of people with a high grade tumor.  My tumor was high grade (grade 3) and the difference in the study was about 10% higher local recurrence rate for those with a high grade tumor that had the Hypofractionated treatment (16 whole breast).  I asked my doctor about this and he said the consensus was that this was not really a concern.  I asked if there were further studies and he said there were not.  I decided that an extra 11 days of going to Ontario was worth the chance of lowering my risk of local recurrence.  It may be that the results were not really indicative of the true implications since the study sample size was small but I decided that peace of mind in knowing I made the best decision with the information available to me at the time was worth the extra 11 days of treatment.

One thing I have learned through this whole process is that you have to be your own advocate regarding your treatment.  I know I made my oncologist upset when I asked some very direct questions regarding my treatment but in reality I think if you dont make them think twice or question them regarding treatment to your body that you arent doing yourself justice.  I questioned my dentist too . . . and I avoided having a bridge because I made him think outside of the box.  I also think of it like the time I went to China and was at their market that was similar to a swapmeet where all prices were negotiable.  I learned I had to insult them by offering a really low price in order to end up with a good price.  I need to make sure my oncologist knows this, but every time I see her it is a whirlwind and I barely have time for my questions.

Back to radiation - I have finished 24 of my 25 whole breast treatments and will complete the 6 boosts on 2/19/13.  I even get to have treatment on the Presidents Holiday.  I am having some skin reactions.  About treatment 18 I started having some pain in my armpit.  They are not targeting my armpit but it is being affected due to its proximity to my breast.  It is only the lower half of my armpit that receives treatment.  It started to look very dark and be painful.  I have been good about putting the Aloe Vera on the area 2 to 3 times a day but it was hurting and looked really dark.  The doctor said it may have been my hair trying to regrow but I didnt believe him.  Then a couple days later I noticed my skin start peeling.  In the dark area there were patches of pink.  I met with a Physicians Assistant who prescribed 2.5% Hydrocortizone as the Aloe Vera will sting once the skin breaks open.  I think that was part of the pain, that the aloe vera was getting in the skin where it was starting to break open.  The PA mentioned that the first areas to have an issue are the ones with skin on skin contact - in my case the armpit and the fold of the breast.  Well thankfully the fold of my breast does not touch anymore since my surgery.  I was also told I could use Aquaphor lotion on the area.  I personally hate how greasy the Aquaphor is but I have been using it along with the Hydrocortizone and using the Aloe Vera on all areas except my armpit.

I am told that the skin can continue to get worse for two weeks after I am done with treatment.  The rest of the treatment area is looking pinkish/brownish, kindof like my skin looks after going to the beach but the color is not evenly distributed - some areas look normal, some are a little brownish, some are pinkish and then the armpit is very dark and my sentinel node biopsy scar is almost black with a little pink where it is starting to break open.