Cutting Weeks Off Treatment: Radiation Gets a Rehab
While it certainly doesn't pack the same emotional kick in the gut as chemotherapy, radiation conjures up visions of burned skin, fatigue, and fear of the unknown: are those high-dose X-rays, administered day after day for weeks, doing me more long-term harm than good?
Thankfully, traditional radiation therapy for breast cancer has improved greatly over the past 20 years. More targeted than ever, the chance that radiation will result in serious long-term issues - e.g., a secondary cancer - is pretty much a non-issue these days.
Still, the treatment can take up to 6 weeks: 5 days a week, Monday through Friday. That can stretch to 7 weeks if you're getting "the boost:" an additional course of focused radiation delivered directly to the site of the tumor.
While the actual radiation takes just 10 to 15 minutes, driving to the hospital, waiting, and driving home takes a chunk of your day: especially if you live a long way from the hospital. Thus for many women, the biggest challenge of radiation is the schedule, rather than the treatment itself.
Luckily, there are a number of new therapies that are radically altering the manner in which radiation is delivered. Many are still in the trial stage, and generally unavailable to the public. But a few are gradually making their way into the mainstream - and if you've learned your treatment plan includes radiation, they're worth checking out.
Accelerated whole breast radiation therapy (AWBRT), a.k.a. hypofractionated radiation therapy
AWBRT uses slightly elevated doses of radiation to shorten the course of treatment to 3 to 4 weeks. Yes, it still involves weeks vs. days (or even hours) of treatment; but it's a start.
This treatment is in the final stages of testing, with patient guidelines - which women might benefit most, and on what exact schedule - being determined. Scattered facilities are offering the treatment, as data-gathering continues; ask your oncologist if your hospital is one of them, and if it might be right for you.
Whole-breast vs. partial-breast radiation
Breast cancer treatment is becoming more and more targeted, and radiation is no exception. Some newer forms of radiation treat just the area where the tumor was removed (partial-breast radiation), vs. the entire breast (whole-breast radiation).
Studies so far indicate that there's no difference in survival rate between these two types of treatment, though there are more local recurrences (return of cancer to the same breast) with partial-breast radiation.
The two treatments described below involve partial-breast radiation. As such, only certain women are good candidates for them; before you research their availability, find out if you qualify. And this could be confusing, as the two main advisory bodies for radiation protocols disagree on the standards.
The American Society for Radiation Oncology advises partial-breast radiation might be a choice for women over the age of 60 who are ER/PR-positive; with no lymph node involvement; and whose tumors are under 2cm. They advise women with DCIS or other non-invasive cancers, and women with multiple tumors, NOT to use partial-breast radiation.
The American Society of Breast Surgeons standards are broader, including women age 45 and older, with either invasive or in situ (DCIS) cancers; whose tumors are 3cm or smaller, with negative margins after surgery; and with no lymph node involvement.
The following two therapies are classified as partial-breast radiation.
Brachytherapy brings radiation directly to the site of the tumor, using small radioactive seeds. These seeds can be delivered via catheter; or, in the case of MammoSite
®, via a small balloon inserted into the space where your tumor was removed. Radiation is then delivered internally (rather than via external beams) twice a day for just 5 days.
The seeds are removed after each treatment, while the balloon or catheters remain in place. Since the treatment is delivered twice daily, most women find it makes sense to stay at the hospital between treatments.
Sound interesting? Read Dani's story, a survivor's first-hand account of MammoSite treatment.
If you decide brachytherapy is for you, you may have to travel to find a facility that offers it. Note that brachytherapy is delivered within days of surgery; so if you've already had surgery, you're probably not eligible. If you're a candidate, but your hospital doesn't offer it, check this link to find facilities that offer MammoSite.
Targeted intraoperative radiation therapy (TARGIT)
This intriguing protocol bypasses the entire radiation schedule, delivering treatment concurrent with surgery. In other words, you wake up from your lumpectomy having already had your radiation.
TARGIT is being offered in scattered locations, but it's not as widely available as brachytherapy. Why not? First, it requires specialized mobile equipment that can be brought right into the operating room. Hospitals will need to purchase the equipment, something most are loath to do in this era of uncertainty around health care and who pays for it.
In addition, the radiation received, though very focused, isn't as intense. And since TARGIT is still so new, there's not enough long-term information to assess how well it'll work compared to traditional radiation.
Still, if the traditional 6-week radiation schedule is going to pose a huge hardship for you - as well it might, given jobs, child care, and gas prices - it's well worth finding out if either TARGIT or brachytherapy is an option.