WHY all the rounds of RAD

brooklyn22, breast cancer in younger patients tends to be more aggressive. So many radiation oncologists prefer the 15 to 16. The 5 fraction treatment does require different equipment. the 5 day is considered for patients over 50 with early detection. You might receive a different treatment plan from a different radiation oncologist or at a larger facility (maybe university affiliated) where they would be likely to have linear accelerator LINAC or 3D CRT/IMRT.

Not too sure abt age related as a reason?

Have you asked the radiation oncologist directly? That will probably yield the most educated response! I also think different centers may offer different treatments.
I had 15 radiation treatments, and it went smoothly. But do ask so options are clearer.

@mir123 I’m asking kind of pun intended - I had basic lumpectomy no nodes margin close NOT TOUCHING onco rad wanted to do 15 treatments full breast I went for 2nd opinion to the head of breast rad onco- they did necessary tests AND take your genomic testing had me do (5) Day target rad // point being WHY one size does not fit all there could be many many of us that did not need 15 days that was my point.

@brooklyn22, that's what I'd be thinking and some research supports your suspicion. https://pmc.ncbi.nlm.nih.gov/articles/PMC8945963/
Another advantage over other technology is MRI guidance. Real time positioning of the targeted area where the machine just stops sending radiation without human response delay is a great advantage over the clumsier CT not-real time guidance.
You might locate the equipment before finding the radiologist. If you tell us your city, we might know where to look.
Five is so much easier and less expensive.
This is somewhat adrift of the conversation, but two years ago I was looking everywhere for The MIRidian Viewray for a friend with prostate cancer. So I know they have them at UCLA, City of Hope, Hoag. Stanford didn't but does and I think has the latest rendition. https://www.youtube.com/watch Mayo didn't, but might now.

@brooklyn22 Excellent point--and good for us to be aware of.

So 5 days is usually a higher dose. I had 600 cGy each day for total of 3000 cGy. In 2022 it was fairly new, and radiation was sequential 5 days.
I had newest tech, hypofractionalized, breath controlled, varying doses with highest level at cancer target.

I don’t usually share this, but because you’re just”asking pun intended”, you might want to know that while 5 days results in fewer immediate skin issues, that doesn’t mean the higher dose doesn’t cause trouble. 2 years after radiation I had another surgery to the radiated breast. I was very thankful that while doing so the surgeon cut out a lump of hardened tissue that over time had started hurting when i laid on my side, radiation caused. The finished outcome also wasn’t as nice as the original surgery because 2 years later my skin had thickened and was not as pliable. It appears that they struggled a bit to get the thickened skin to shape nicely and the sutures looked like they were pulling a purse string. I don’t think this was lack of surgical skill. I also have a seroma along that area because the skin just was difficult to get flat at the sutures.

Its 1 1/2 years since last surgery. Although the breast looks fine, that tight suture area gets sore by the end of the day. I feel lumps and bumps in the radiated area. I keep my fingers crossed that it won’t harden anymore.

So yes, there may be reasons women want lower doses over more days. If I were having a mastectomy or further surgery after radiation I’d definitely check whether the outcomes over time would end up better with the longer radiation plan. My experience is that it might be better.

15-16 smaller radiation doses might not have caused this issue. I guess we can only wait and see how the 5 day higher dose looks in 10-15 years.

Honestly your “pun intended” affects women everywhere who tried to make the best decisions on the knowledge they had at the time.

@triciaot sorry to hear of your outcomes my
pun intended is not directed to anyone fighting the fight!!!!! My goodness we are all in this together! I ASKED for a 2nd opinion I went by my genomic testing results size and N Nodes!!!!! (3) Onco Score— unfortunately there are radiologists out there that are not comfortable with 5 day target when a margin is CLOSE but NOT touching
my entire point of this is be your OWN advocate in every situation.

@brooklyn22 yes there are radiologists out there that are not comfortable with 5 day target when a margin is close but not touching, because they're waiting on studies that can replicate the original research. Practice changes usually don’t happen until multiple studies show the same result. Its for our safety.
I only had a 1 mm margin, but 5 days were allowed because it was just a focal point margin, and, because I was at a comprehensive cancer center that does a lot of research.

My fear is that 5 day radiation might be pushed as a good solution because the insurance companies like the idea, and easily approve it. Same with the wait and see idea of limiting surgery. Shorter radiation days and no surgery might be a good option for some, but it becomes worrisome when it is the protocol du jour.

Know the risks and as much about the outcomes as possible before making a decision.
5 day radiation, is great because its short, it usually causes less outer skin damage, and early research shows it provides equivalent recurrence protection.
My outcomes after 3 1/2 years? Hardening of breast tissue, massive thickened skin, higher risk of seroma with future surgeries, higher risk when shaping breast due to thickened skin.
Whether this would be less with 15 radiation sessions I’ll never know. But the idea of the higher number of sessions with lower dose is to prevent these effects.

The outcomes of long/short radiation might make a difference to someone who knows they’re likely to have surgery after radiation or reconstruction on the exiting breast after radiation.
Higher rads=likely damage=less flexible soft tissue