DCIS is why I became a rad onc. My mom got DCIS and through her treatment process I met her rad onc and thought he was the smartest coolest guy ever. I went with her to many of the treatments. I knew nothing medically back then. However I do clearly remember her getting 33 treatments.
She hasn’t seen her rad onc in about 15 years and maybe rightly so (she’s about 25y out from dx), but if she did I bet he’d be shocked. She doesn’t really have a left breast anymore as much as a fieldstone. It’s a source of constant minor irritation to her. I haven’t actually seen it because I’m afraid to probably. But on palpating it feels unnatural. She resigns herself to the problems because she knows she had “breast cancer” and the radiation was necessary. I don’t disagree with her ever.
I don’t know if her travails should or shouldn’t color my thinking. Probably shouldn’t. But it does. At SABCS they’re talking about PRIME in invasive; ~10% LC improvement with RT but maybe consider skipping RT altogether. I don’t buy that. But I have to give the logic some credence. Will I ever boost DCIS? Maybe. Would I ever use 16/8 with hypofx? Not in a million years. I bet few of you would either. So let’s all just retreat back to our own logical melanges and biases and give 5 times two or 4 times 2.5 or whatever. Because “it makes sense.” But if we aren’t doing “it” rather similar to what was done in the trial... what purpose was the trial? Proof of concept? Maybe. The therapeutic window in invasive breast cancer is annoyingly narrow; it’s probably insanely narrow in pre-invasive disease.
