Monday, December 19, 2011

Lumpy

Tomorrow is my lumpectomy for DCIS (Stage 0 breast cancer) plus IORT (intraoperative radiation therapy), and I’m still fretting about the latter. I gave Dr. L., my radiation oncologist, a call today, but he wasn’t around, so I spoke with the on-call physician, who was very kind and patient.

I mentioned a worrisome New York Times article I’d come upon regarding conventional external radiation versus the one-week, two-times-a-day course of treatment, which is considered to be equivalent to IORT, and the on-call physician said he could see why I was concerned, though he reiterated that I have pre-cancer, so any numbers that pertain to cancer should be even better in my case.

He agreed there is a 5% risk of having to have a mastectomy in the five years after having the short course of radiation and a 2.5% risk of the same with conventional radiation—that is, the risk of mastectomy appears to be doubled with the short course of radiation, but this may not have any effect on long-term survival one way or the other. 

He offered me three choices to consider:

—Conventional external radiation for several weeks.

—IORT as planned. People with invasive cancer would have a 95% chance that nothing else would ever happen; a person with DCIS should theoretically have even better odds.

—A hybrid: one could use the IORT at the time of surgery as the “boost” (precise treatment of tumor bed) that typically comes at the end of a course of external radiation, and 4-6 weeks after the lumpectomy, have a course of external radiation shorter than the conventional course.

I also spoke with my surgeon, Dr. P., who said we don’t have 10- or 15-year data on DCIS, but we do have long data for surgery plus the short course of radiation treatment, which is similar to IORT, and that data shows a 4% chance of recurrence over 10 years, which is a fairly small risk.

It has been a long and not very fun day of Googling.
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