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Nadine

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Reply with quote  #1 
Hi, I am the new kid on the block. My cancer is very small 1cm, clean edges at least that is what the biopsy etc show. Had a couple different choices as to the treatment. I choose to have a lumpectomy w/lymph node dissection. To be followed by radiation, hopefully using the newer intracavitary brachytherapy.. If edges are clean and lymph nodes are clear. It is my understanding I can have this. Radioactive seeds are place into the space left by the surgery by a tube w/ inflated balloon. Twice a day for 5 days and then it is finished.  Has any one one this forum had this done? 

To be truthful I am not really terribly worried about the cancer for at this point I know it has been caught early etc. But I have a another problem that makes the anesthesia more of a concern than usual.  A valve that will be replaced in short time to a few yrs and is consider serious but no enlargement or backup at this time. I now am on oxygen too.  Just makes the surgery more scary, that is all. So this is where I am at this time.

So anyway, I really wanted to know about the radioactive seed treatment. I am having this done in a city that is a good hr from home. My daughter lives there and no problem staying there. She and her husband both work and I am hoping that I will be able to drive myself to and from their home for the treatment.  My hubby would then be at home and take care of the farm, so to speak. This is down the line after and if surgery goes well. But just want to look ahead.l 

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Nadine
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Reply with quote  #2 

Hi NADINE! I put a question to the gals in the Wagon Circle to see if anyone could help you. Many of our gals are at Pinkstock right now, a meet of the BC sisters so might be a bit before someone answers.


NADINE> I found this website that sounds like what you are getting as rads.
http://www.mammosite.com/breast-lumpectomy/whatis-mammosite.cfm

There is a discussion going on about this type of rads at the bco site...you can get an idea of what some of the ladies have been through already with MammoSite rads.
http://community.breastcancer.org/forum/70/topic/701456


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Reply with quote  #3 
Hi Nadine,
I have heard many great things about this type of radiation. Particularly the shortness of the duration of treatment.

I think there is very light anesthesia if any for this procedure so it shouldn't be a cause for concern.

I did look up some info for you and the one I found at Breast Cancer Connections, a part of Stanford University Hospital, seemed the most complete.
I hope this helps.
and WELCOME! I am sorry for the reason you are here, but very happy that you found us.
hugs,
Gina

What's New in Radiation Therapy? Accelerated, Partial Breast Irradiation for Breast Cancer

               

By Frederick M. Dirbas, M.D.

Over the past 30 years, breast preservation has become an increasingly common choice for women with newly diagnosed, early stage breast cancer. With this approach physicians are able to remove a malignant breast lesion with a margin of normal surrounding tissue (lumpectomy), then apply approximately 6 ? weeks of radiation to the whole breast to minimize the possibility of an in-breast tumor recurrence (local recurrence). Prior to breast conservation, virtually all women with operable breast cancer underwent a mastectomy. We now have long-term studies that demonstrate equivalent local control and overall survival with lumpectomy followed by radiation compared to mastectomy.

Recently, attempts have been made to abbreviate the 6 ?-week course of post-lumpectomy radiation. These attempts are the result of preliminary studies demonstrating that it may be safe to deliver shorter, more intense courses of radiotherapy (accelerated irradiation) to a more focused part of the breast (partial breast irradiation). Accelerated, partial breast irradiation (APBI) trials are now being developed to test this approach using a variety of different forms of irradiation. These APBI trials typically use radiation over a 1- to 5-day period with a range of 17 Gy (Gray, a standard unit of radiation dose) to 38 Gy, rather than over 6 ? weeks with a dose of approximately 60 Gy. These protocols also treat just the breast tissue around the lumpectomy cavity, rather than the whole breast, as this is the most likely place in the breast for tumor recurrence.

The potential benefits of APBI are significant. Although 6 ? weeks of daily radiation is not especially prolonged, the treatment affects quality of life and disrupts normal activities for virtually all who receive it. For some, the inconvenience is more substantial, and the therapy interrupts significant work and/or family obligations. For a few, in particular the elderly, the treatment is a true hardship due to distance or travel limitations. These women may forego radiation, which can raise the local recurrence rate, or simply opt for a mastectomy. These difficulties have led to a documented underutilization of breast conservation. There is also evidence that whole breast irradiation does not significantly reduce the rate of tumors that develop after lumpectomy in other breast quadrants not affected by the initial cancer; this suggests that for some women, whole breast irradiation may be overtreatment. Finally, women who have standard breast conservation and then experience a recurrence are typically referred for mastectomy, rather than repeat breast conservation, this because it is considered unsafe to therapeutically irradiate the breast twice. Accordingly, if APBI were successful, a number of possible improvements in breast cancer care could be seen. Women who pursue breast conservation could enjoy an enhanced quality of life. The percentage of women who pursue breast conservation might increase. Whole breast irradiation could give way to more focused treatments that spare normal breast tissue in other quadrants. And women who experience an in-breast tumor recurrence (local recurrence) after breast conservation might be candidates for repeat lumpectomy.

Unfortunately, initial attempts at APBI were unsuccessful. In the late 1980s and early 1990s, two studies looking at this approach were performed in England. One of these, performed at Guy's Hospital, utilized interstitial brachytherapy ("brachy" is Greek for "close"). Radioactive seeds were placed in a series of tubes into the breast tissue (interstitial) around the surgical cavity for 5 days after tumorectomy (gross excision of the tumor, without careful attention to margins). The second study, at Christie Hospital, utilized a 10-day course of external beam irradiation, also after tumorectomy. In both studies, physicians noted that in-breast recurrence rates were much higher after APBI than those seen with whole breast radiotherapy. These unsuccessful attempts at demonstrating the effectiveness of APBI led to considerable frustration. The idea of altering standard post-surgical external beam radiation was almost abandoned.

However, a few physicians continued their investigations into APBI in the early 1990s. Chief among these were Dr. Robert Kuske, who began his work at Ochsner Clinic in New Orleans, and Dr. Frank Vicini, working at William Beaumont Hospital in Detroit. Dr. Kuske pursued intersitital brachytherapy similar to that studied previously at Guy's Hospital, but with two important differences: first, he utilized a technique of radioactive seed placement that far more effectively covered the area around the surgical cavity (typically covering ? to ? of the entire breast); second, he only treated women who had a true lumpectomy, in which assessment of surgical margins by a pathologist demonstrated that the tumor was excised with a margin of healthy tissue. Dr. Vicini also utilized interstitial brachytherapy, but with his own variations. He treated a more limited margin around the lumpectomy cavity, usually 1 to 2 cm, but with even stricter patient selection criteria. In Vicini's study, the margins had to be clear by a minimum of 2 mm, tumors had to be less than 3 cm in size, and only women over age 40 were accepted for inclusion. Also, certain types of tumors, such as lobular cancers, which can recur more frequently, were excluded. Vicini's selection criteria were based on decades of observational studies of women who had undergone lumpectomy for breast cancer with careful attention paid to risk factors for recurrence. In both Kuske's and Vicini's studies, women were treated over 4 or 5 days with approximately 34 to 38 Gy.

By using careful treatment planning techniques and relatively strict patient selection criteria, first Dr. Kuske and then Dr. Vicini reported the first successful studies of APBI. Dr. Kuske's first publication reported only one in-breast recurrence in 51 cases with a 3- year median follow-up. Dr. Vicini more recently reported 5-year median follow-up data on 199 women in his trials with a 5-year actuarial local recurrence rate of 1%. This was equivalent to results seen in a matched population of women receiving whole breast radiotherapy at his institution. The work of these two investigators stimulated renewed interest in APBI as a viable alternative to 6 ? weeks of whole breast radiotherapy. Confirming the results of Kuske and Vicini, Wazer at the New England Medical Center (location?) reported early results from a small, multi-institutional trial showing excellent local tumor control without appreciable side effects with 3 years of follow-up.

Despite Kuske and Vinici's work, interstitial brachytherapy has not become commonplace. In part, this is due to natural caution regarding a new approach. The complexity of the interstitial brachytherapy technique with its need for special radiation oncology skills made its adoption difficult. The procedure requires the placement of 10 to 20 catheters in the breast after lumpectomy, sometimes requiring a second operation. Furthermore, the appearance of the breast during treatment, with many catheters protruding, has been considered visually disturbing to patients and physicians alike. Accordingly, by the end of the 1990s, though interstitial brachytherapy appeared promising as an effective way to accomplish APBI, few centers were offering the treatment.

Since 1999, new APBI approaches have become available, generating renewed excitement in the approach. These new techniques include intracavitary brachytherapy, intraoperative radiotherapy (IORT), and accelerated external beam radiotherapy (3-D Conformal APBI).

Intracavitary brachytherapy, conceptually the closest of these new approaches to interstitial brachytherapy, relies on a radioactive seed placed within a balloon catheter device (MammoSite?, Proxima Therapeutics, Inc.) that fits inside the lumpectomy cavity. The MammoSite can be placed at the time of the lumpectomy or afterwards, under general, or local, anesthesia. The ease of device placement has been confirmed by the use of over 1,500 MammoSite device placements in the United States within a year and a half of its FDA approval date in May, 2001. (Note: FDA approval indicates the device is approved for brachytherapy delivery, but does not make a statement on effectiveness of treatment. This is pending current clinical trials). While many feel that this device combines the effectiveness of interstitial brachytherapy with the ease of a simple balloon catheter deployment, it remains to be seen whether a single radioactive seed placed at the center of a lumpectomy cavity can provide the same effective coverage of breast tissue as a seed that is placed in dozens of different locations in the breast tissue around the lumpectomy cavity. The key limitations of the device are that the breast tissue must be greater than 3 cm in thickness where the MammoSite device is placed, and there must be at least 7 to 10 mm of distance between the MammoSite balloon and skin to prevent skin injury and possible wound breakdown. The MammoSite is used to deliver 34 Gy over 5 days in a total of 10 fractions (doses).

Another new APBI approach relies on delivery of radiation to the breast tissue around the lumpectomy cavity while the patient is still in the operating room, immediately after the lumpectomy has been performed (intraoperative radiotherapy, or IORT). First performed on a very limited basis to deliver just a portion of the complete radiation treatment in Ohio and in France over a decade ago, the IORT technique has been modified and introduced in a large clinical trial now taking place in Milan, Italy. Using this approach, a sentinel node biopsy is performed, followed by a lumpectomy (the Italian group actually performs a quadrantectomy, a somewhat wider excision than a lumpectomy), much as a surgeon normally would do. If the sentinel node appears free of tumor, and if the tumor appears excised with clear margins (both may require evaluation of the tissue by a pathologist during surgery), the surgeon frees up the breast tissue surrounding the lumpectomy cavity and gathers it together with sutures to create a focus of breast tissue known as the target volume. After a thin, lead plate is placed behind this target volume of breast tissue to protect underlying muscle, rib, lung, and heart, a lead cylinder is - focused on the target volume of breast tissue. Radiation is then delivered through the cylinder directly to breast tissue through the lumpectomy incision. In this way, a single large dose of radiation is delivered only to the breast tissue without affecting surrounding normal structures, including skin. Depending on the machine utilized to deliver the radiation, the treatment takes anywhere from 4 to 18 minutes. The equipment is then removed, and the incision is closed, with no further radiation treatments required. The greatest limitations of the IORT technique are: the status of the lumpectomy margins is not definitively known until after the radiation is delivered; the treatment lengthens surgery by approximately an hour to an hour and a half; the equipment needed for IORT is available in relatively few hospitals around the world; and the single large dose of radiation has limited long-term follow-up in terms of toxicity and effectiveness. (A new device, the IntraBeam?, may also be able to offer intraoperative radiotherapy, but thus far its role has largely been limited to delivering a boost dose to the lumpectomy cavity margin, rather than the equivalent of the entire whole breast treatment.) Although long-term data for IORT are critical, early results from Milan are very encouraging. The Milan group has now treated several hundred women in this fashion beginning in 1999, and based on preliminary findings the group has commenced a randomized study directly comparing IORT to conventional 6 ? weeks of whole breast radiotherapy. (Of note, the same Milan group was one of the first to rigorously study breast conservation surgery.) At last report from Milan, there were 360 women in each study group with complete accrual anticipated in 2005. The dose of radiation delivered to the breast tissue with this single fraction approach is between 17 and 21 Gy. Our group is currently offering IORT at Stanford, for both invasive breast cancer and DCIS, one of only two sites outside Milan where the technique is actively under study.

The third additional APBI approach is a variation on the traditional external, whole breast radiation treatment currently used for breast cancer. Referred to as 3-D conformal APBI, the treatment delivers a more focused radiation beam twice a day over a 5-day period only to breast tissue around the lumpectomy cavity using a linear accelerator (a linear accelerator is commonly used to perform the standard 6 ?-week whole breast radiotherapy). This technique was also pioneered by Dr. Vicini in Michigan. There is great hope that this technique will be successful, but published results using this approach are limited to only 30 patients. While the treatment was well tolerated in this limited series, treatment planning is complex. Adjustments had to be made for respiration, and there is concern that the linear accelerators currently in use for whole breast radiotherapy can't treat at the angles needed to safely deliver APBI with this approach. There is also no long-term data on its safety or effectiveness. This 3-D conformal approach delivers 34 to 38 Gy over 5 days in a total of 10 fractions.

In the coming months and years we will undoubtedly see trial results with interstitial brachytherapy, intracavitary brachytherapy, IORT, and 3-D conformal techniques. In the short term, we will track potential complications from the higher doses of radiation such as wound healing problems, infection, and fat necrosis, while longer term complications could include fibrosis (hardening) of the breast tissue as well as untoward cosmetic results from increased scar formation. Of course, the in-breast cancer recurrence rates will be watched carefully to see if one, or several, forms of APBI delivering radiation over 1 to 5 days can provide as safe a reduction in cancer recurrence in the breast as traditional 6 ? weeks of whole breast radiotherapy. Because of the novel nature of these trials, it is very important for women considering this approach to pursue it at a facility that is offering APBI as part of an institutionally approved clinical trial. Looking to the future, while the trials of Kuske and Vicini demonstrated the effectiveness of APBI for women with invasive cancer, new trials are looking at extending this approach to women with ductal carcinoma in situ (DCIS).

If these APBI treatments are proven safe and effective, quality of life will be improved for many women with breast cancer. Much as lumpectomy provided a safe, effective alternative to mastectomy, APBI may provide a safe effective alternative to the whole breast radiotherapy approaches that have been in place around the world for nearly 40 years.

  • Resources
    • Call or visit BCC's library to access the text of the JNCI article on the Vicini clinical trial mentioned above or for related abstracts from recent scientific meetings.
  • Peninsula facilities offering APBI
    • MammoSite:
      • Mills-Peninsula Hospital (contact Steve Kurtzman, M.D.)
      • Stanford Hospital (contact Fred Dirbas, M.D. or Don Goffinet, M.D.)
    • IORT:
      • Stanford Hospital
    • 3-D Conformal APBI:
      • Stanford Hospital
               
               


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Nadine

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Reply with quote  #4 

Thank you, I have done lots of research on this too. There are many websites and I think I have made myself blind reading.  I just really want to hear from those that have had it done. Are they able to go on about their business without a problem. Safe to drive etc. I am trying to decide if I should keep my car and do my own driving to and from so I don't have to put my daughter and son-in-law out. They both have jobs and I will probably be staying with them since I will be in Colorado Springs, a good distance from home.  A good half hr. from treatment to their home at good times but others could be longer, when city traffic to deal with. I am hoping I can more or less take care of myself for that 5 days. Thanks again.


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Nadine
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Reply with quote  #5 

Hi Nadine,
I would go to the BC.org site, seems to be a great discussion going on there among women who have had this procedure.
 
I recall downloading an application for Clinical Trials being held at John Hopkins, or Sloan Kettering, before I had chemotherapy or radiation treatment.  I inquired, to the surgeon who performed a partial mastectomy and sentinel node biopsy, being Stage 1b, Grade 3, IDC, Triple Negative Hormone Receptors, and no apparent lymph node involvement.  He said he had enrolled two women into the study; unfortunately, because I was classified as "High Risk", it eliminated the possibility of having the less invasive Radiation Particle Therapy.  I had an aggressive tumor, however, it's activity, appearance and location (2.mm from the chest wall), were enough to disqualify me from the trial.
 
Hopefully, this is encouraging news for you, because (according to the Radiation Oncologist and the Chemotherapy Oncologist), High Risk, challenged breast cancer patients are not considered as viable candidates for this procedure.  I completed my last chemotherapy approximately to date, two years ago.  October will mark my 2 and 1/2 years completion of 33 radiation treatments.  Dec. 15, will be the third year since the surgery.  It all seems like yesterday, the time flew by. 
 
Good luck with your therapy and decision.  It sounds like you will be fine.  I drove myself to Radiation Treatments every day, five days a week, and never missed a single treatment.  The drive was almost 2 hrs. one way, and I would usually see some friends, have lunch, coffee, shop, rest a little, and then return home.  The side effects and fatigue didn't really affect me until the last two weeks; ending with a "boost" Radiation Treatment finale. 

Previous to Rads, I was given 12 wkly Taxol Chemo Treatments; I was allergic to Taxol and given mega-doses of Steroids (Decadron), and I think it gives us "super-power".  When the steroids wore off, my energy was zapped.  The side effects of Radiation Therapy didn't affect me until 4 or 5 months after the final treatment.    That's my theory, anyway.
 
Good luck with your decisions, I know how difficult it is to choose when (however too few) options are presented to you in alien jabber-wacky dialog and Medical terminology...don't feel alone.  Unless you are lucky enough to be a doctor, nurse, or involved in the medical profession, it's a quick-course in med. school, when we are making decisions about complicated issues unknown; hoping to get through the magic time window, and trust our "team", is not easy. 
 
(((gentle hugs and prayers your way)))
 
Indi

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Reply with quote  #6 
Dear Nadine,
Is there a reason why you prefer this type of radiation over the regular radiation?

When I was first diagnosed in 2001 I had "regular" radiation. Then when I had it again this year I had IMRT radiation which is a more concentrated beam that spares the healthy tissue. I didn't have burns or anything with this new, targetted treatment and there was no need for anesthesia and I could drive, swim, garden, you name it.


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Karen1956

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Reply with quote  #7 
Nadine - I  had the "traditional" radiation Tx - 25 in all.  I went after work and drove myself there.  DH came on the visits that I was seeing the rad onc, but he met me there - that is because I always wanted some one to be with me when I saw the doctor so I wouldn't forget anything.  I started rads 3 weeks post chemo.  Fatigue was the biggest issue (besides burning and itching but that was managed with cremes and domobora soak) and I just had to be sure that I did not over do it at home or work.  I always wore two piece outfits, so I only had to take my top off when I put the gown on.  This was suggested to my by someone I worked with who had rads, but she did not have chemo, so this helped  her with hair and make up.
Good luck to you.  
Nadine

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Reply with quote  #8 

Why this radiation treatment? If what they believe is true, when all the info is in after surgery confirms. It targets just the cancer area. Not the whole breast and from what I have learned from others here, it is just a heck of a lot easier and over in 5 days.  Tests show it is very effective from my type and size. Thanks guys for your answers that have confirmed I should be able to drive myself to and from treatments. I hope to stay in Colorado Springs and not drive everyday to and from home. The price of gas and all. 5 days is not long to be away.  


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Nadine
nosurrender

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Reply with quote  #9 
Yes, Nadine, I am sure it is easier to be done in five days! I know that regular rads sure do drag on.

I hope you will be able to get it done and overwith and be able to get back to your regularly scheduled life again.

Please keep us posted!!!

Hugs,
g


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patty

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Reply with quote  #10 
I discussed this type of radiation with my doctor but he advised against it because of the high rate of infection that it causes. Has anyone else heard about this? I would love to be done in five days.
Nadine

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Reply with quote  #11 

Gee, I have not read anything about the infection rate being any higher. I have 4 doctors in my family. Not cancer doctors but internist, cardiologist, gynecologist and a general practitioner. Non live in my state but I have traded e-mail with them. Non mentioned that in their research either. Maybe that is a question I should ask.


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Nadine
Karen1956

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Reply with quote  #12 
Nadine - where are  you at?  I'm in Denver. DH!!!  Just realized (of course after seeing my post) that my signature mentions Denver - Karen
Nadine

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Reply with quote  #13 

I am in Canon City. My reg. Dr. is here. But for more specialised treatment, we go to Pueblo or Colorado Springs. Some op for Denver.  If I can avoid Denver area, I do. If the light rail don't go. I don't go. LOL I just cannot deal with the traffic. Have done so on the interstate to get to Boulder, Fort Collins etc. but not by choice. I am more a country girl, just do not care for neighbors living in my pockets. LOL  My Gdaughter is up there and loves it. Good thing we all don't like the same thing.


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Nadine
Karen1956

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Reply with quote  #14 

Nadine - well, if  you ever get to Denver, let me know and maybe we can meet for coffee, ice cream etc.  Hugs to you.

Nadine

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Reply with quote  #15 

Thank you for the invite. Might just take you up on it someday.


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Nadine
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Reply with quote  #16 
Nadine,
I have been meaning to tell you how much I like your avatar.

I have heard of a couple of people who did get infections from that radiation technique. One is a woman from bco and I think she had a terrible time with healing. I am not sure if she had the exact same kind as you will be getting and it was a few years ago, so they must have improved it since then. The other is my friend's aunt who also had trouble healing afterwards. It is a certainly a question to bring up before you make your final decision. I will do some research for you too.


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Nadine

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Reply with quote  #17 
That is one of my rescue kittys, I picked up on a city street, or rather she picked me up by jumping into my pickup 3 times before I gave in. Poor baby was thin, mites and real mess and definitely determined to find a caring home. Animals have their ways of speaking.  

In the research I am my family of doctors have found. 1. The number of infections were very very low, and whether caused by the method of treatment or the surgery is in question. 2. It seems that the putting in the shunt and balloon at surgery a patient having that time with tube protruding, instead of waiting that week or whenever treatment is started to place it, may raise the danger of infection. At least that is what I am getting from various sources. When I questioned my surgeon  she said that she and the radiologist preferred it because, the time laps between surgery and treatment can vary for several reasons. Having the tube there for several weeks instead of the 5 days raises the danger in their minds. Sounds reasonable to me.   

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Naniam

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Reply with quote  #18 
Nadine,

Just saw your post.  Have been gone for a few days.  The mother of one of the doctors that I worked for had this form of radiation.  She was 84 at the time.  I'm not sure when they inserted the tube, I'm thinking at the time of the surgery but she loved the radiation being given this way.   Sure sounds better than the 36 treatments I had.   I think maybe because of her age, her son or DIL drove her for these treatments; I drove myself every day for mine and was fine with that too.

Good luck, you have done your homework and that matters lots.    Brenda
Nadine

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Reply with quote  #19 

I'm not that old but getting there faster than I care to.


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Naniam

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Reply with quote  #20 

I know that feeling - my body feels very old at this point!!

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