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		|  11-29-2007, 11:02 PM | #1 |  
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				Radiation - "blanket" ??  help
			 
 Ruth has started her radiation therapy.  I was with her at the initial consultation, but have not been going with her to the actual therapy.  They are using some sort of "Blanket" every other day which she cannot explain to me nor did the Dr. tell us that would be used.  Ruth says the  technician said the skin irritation typically starts much earlier with its use. (3 weeks out vs 5 weeks)  The only thing I can find on the web, and VERY limited info, is that this might be an immobilization blanket.  The study I saw was 2005, so pretty recent.  I cannot determine if this is something that helps Ruth's therapy and/or makes it safer for her or if it is simply something that makes their job easier but with potentially more consequences for her.
 Can anyone help?  She just saw the Dr yesterday, so won't see again personally until next week.  I so appreciate your help as always!
 
 Terri
 
 PS Ruth's cancer was on the right side, so I don't think this is heart related?
 
				__________________Terri, spouse of Ruth, Dallas/Ft. Worth area
 Ruth dx 05/01/07 (age 50) Filipino
 multifocal, several tumors .5 -2.5 cm, large area
 Breast MRI showed 2 enlarged nodes, not palpable
 100%ER+, 95%PR+, HER2+++
 6x pre-surgery TCH chemo finished 9/15/7  Dramatic tumor shrinkage
 1 year Herceptin till 6/08
 MRM 10/11/07, SNB: 0/4 nodes +  Path: tumors reduced to only a few "scattered cells"
 now 50% ER+, PR- ???
 Rads finished 1/16/08
 Added Tamoxifen,
 Finished Herceptin 05/08
 NOW is the time to appreciate life to the fullest.
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		|  11-29-2007, 11:04 PM | #2 |  
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				Join Date: Feb 2006 Location: Acworth, GA 
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	 | Terri, 
 When I had radiation the last week of it was called "boosts" and they used somewhat of a blanket.  I think that is what's happening.  It gives a stronger dose to specific areas.  Glad Ruth is doing so well.
 
				__________________Kate
 Stage IIIC Diagnosed Oct 25, 2005 (age 58)
 ER/PR-, HER2+++, grade 3, Ploidy/DNA index: Aneuploid/1.61, S-phase: 24.2%
 Neoadjunct chemo: 4 A/C; 4 Taxatore
 Bilateral mastectomy June 8, 2006
 14 of 26 nodes positive
 Herceptin June 22, 2006 - April 20, 2007
 Radiation (X35) July 24-September 11, 2006
 BRCA1/BRCA2 negative
 Stage IV lung mets July 13, 2007 - TCH
 Single brain met - August 6, 2007 -CyberKnife
 Oct 2007 - clear brain MRI and lung mets shrinking.
 March 2008 lung met progression, brain still clear - begin Tykerb/Xeloda/Ixempra
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		|  11-29-2007, 11:12 PM | #3 |  
	| Senior Member 
				 
				Join Date: May 2007 Location: DFW area (TX) 
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	 | Thanks Kate for replying so quickly.  I'm glad that YOU are doing better...
 Ruth was to get a mastectomy scar boost the last week.  But she has just started!  I was very specific to ask about axilla boost, as the evidence I had seen did not point to its usefulness anyhow, and everyone agreed that Ruth did not need axilla boost.
 
 I'm still puzzled and concerned...
 
 THX
 
 TRS
 
				__________________Terri, spouse of Ruth, Dallas/Ft. Worth area
 Ruth dx 05/01/07 (age 50) Filipino
 multifocal, several tumors .5 -2.5 cm, large area
 Breast MRI showed 2 enlarged nodes, not palpable
 100%ER+, 95%PR+, HER2+++
 6x pre-surgery TCH chemo finished 9/15/7  Dramatic tumor shrinkage
 1 year Herceptin till 6/08
 MRM 10/11/07, SNB: 0/4 nodes +  Path: tumors reduced to only a few "scattered cells"
 now 50% ER+, PR- ???
 Rads finished 1/16/08
 Added Tamoxifen,
 Finished Herceptin 05/08
 NOW is the time to appreciate life to the fullest.
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		|  11-30-2007, 12:18 AM | #4 |  
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				Join Date: Apr 2007 Location: LA LA Land 
					Posts: 1,607
				 
		 
		 
		
		 
		
		
	
		
	
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				I think it's a gel pack
			 
 I had radiation in Feb '06 and they used a thin gel pack which they laid on me and then radiated.  It was to spare my skin from burning - it allows the radiation to pass thru but spares the top of your skin from the usual irritation.  I think that's what it is!  She can ask the technician for a better explanation.  The "boost" is usually at the very end and is a concentrated zap.  I also did radiation in 1996 so I will say that compared to chemo it's a cake walk.  In '96 I burned so badly that I wore artificial "skin" for the last week.  Just for the record,  I was still super woman and got up, got dressed and functioned every day.  Once radiation ends, I think there is fatigue like no other.  You can really flat line late in the day.  But it WILL pass.  It just takes time for your body to process and eliminate the  fallout from the treatment.  What we endure to LIVE! 
				__________________1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
 2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda.  Finally stops spreading.
 2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
 ‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
 ‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
 1/2006 Rads again,  to scar line. NED.
 
 3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
 12/07 Herceptin.Tykerb. Markers go stable.
 2/8/08 gamma knife 13mm stupid brain met.
 3/08 Herceptin/tykerb/avastin/zometa.
 3/09 brain NED. Lungs STABLE.
 4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
 9/09 MARKERS normal!
 3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
 Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
 Dec 2010 Brain NED, lungs/sternum stable. markers normal.
 MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
 May-Aug 2011 Tykerb Herceptin Xgeva.
 Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
 April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
 OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
 12/20/12 add in PERJETA!
 March 2013 – 5 YEARS POST continue HAPZ
 APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
 May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
 June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
 Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
 Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
 December '13 BRAIN MRI ned in da head.
 Jan 2014: CONTINUING on HAPX…
 FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
 3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
 4. scattered lung nodules, up to 5mm in size = stable, no increased activity
 5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
 APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
 October 2014: hold avastin, continue HPX
 Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
 Continue HPX. Adding back Avastin
 Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
 December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
 Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX.  I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
 Markers drop post rads.
 2/24/16 HAP plus X - markers are down
 SCIATIC PAIN DEAL BREAKER.
 3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
 APRIL 2016 - 9 YRS MBC
 July 2016 - continue HAP plus Xgeva.
 DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad.  Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
 APRIL 2017 10 YEARS MBC
 December 2017 - Progression - gonna switch it up
 FEB 2018 - Kadcyla 3 cycles ---->progression :(
 MAY30th - bronchoscopy, w/foundation1 - her2 enriched
 Aug 27, 2018 - start clinical trial ZW25
 JAN 2019 - ZW25 seems to be keeping me stable
 APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
 MAY 2019 - progression back on herceptin add xeloda
 JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
 10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
 12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved  or improved results.  Markers near normal. I'm stunned but grateful.
 10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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		|  11-30-2007, 03:36 AM | #5 |  
	| Senior Member 
				 
				Join Date: Aug 2006 
					Posts: 492
				 
		 
		 
		
		 
		
		
	
		
	
	 | Terri,
 I think the pad/blanket is called a bolus.  For me, it was a thick gel pad.  They explained it to me as keeping the radiation near the skin, to keep it from penetrating deeper.  The gel pad has the consistency of the skin itself. Good for getting the skin a bigger dose. This is the tissue with the most risk, want to keep the radiation away from my heart- left side mastectomy for me.  Bad news is it causes the tissue to break down more.  I did fine until about #20.  Then they discontinued using the bolus.
 
 Hope it all goes smoothly for Ruth.  I just love the picture of you two!
 
				__________________Are we there yet?
 
 
 Dx 10/05 IDC, multi-focal, triple +, 5 nodes+
 MRM, 4 DD A/C, 12 weekly taxol + herceptin
 rads concurrent with taxol/herceptin
 finished herceptin 01/08
 ooph, Arimidex, bilateral DIEP reconstruction
 NED
 Univ. of WA, Seattle vaccine trial '07
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		|  11-30-2007, 06:38 AM | #6 |  
	| Senior Member 
				 
				Join Date: Feb 2007 Location: Paris, France 
					Posts: 858
				 
		 
		 
		
		 
		
		
	
		
	
	 | 
 I had the sames explanation about the "blanket" as Margerie. It was to keep the radiation on the surface since it was on my left side. The skin burned at the end. I have a big rectangle now on my thorax because my skin pigmented. I finished radiation 8 months ago.Michka
 
				__________________08.2006 3 cm IDC Stage 2-3, HER2 3+ ER+90% PR 20%
 FEC, Taxol+ Herceptin, Mastectomy, Radiation, Herceptin 1 year followed by Tykerb 1 year,Aromasin /Faslodex
 
 12.2010 Mets to liver,Herceptin+Tykerb
 03.2011 Liver resection ER+70% PR-
 04.2011 Herceptin+Navelbine+750mg Tykerb
 06.2011 Liver ned, Met to sternum. Added Zometa 09.2011 Cyberknife for sternum
 11.2011 Pet clear. Stop Navelbine,  continuing on Hercpetin+Tykerb+Aromasin
 02.2012 Mets to lungs, nodes, liver
 04.2012 TDM1, Ned in 07.2012
 04.2015 Stop TDM1/Kadcyla, still Ned, liver problems
 04.2016 Liver mets. Back on Kadcyla
 08.2016 Kadcyla stopped working. mets to liver lungs bones
 09.2016 Biopsy to liver. no more HER2, still ER+
 09.2016 CMF Afinitor/Aromasin/ Xgeva.Met to eye muscle Cyberknife
 01.2017 Gemzar/Carboplatin/ Ibrance/Faslodex then Taxotere
 02.2017 30 micro mets to brain breathing getting worse and worse
 04.2017 Liquid biopsy/CTC  indicates HER2 again. Start Herceptin with Halaven
 06.2017 all tumors shrunk 60% . more micro mets to brain (1mm mets) no symptoms
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		|  11-30-2007, 08:58 AM | #7 |  
	| Senior Member 
				 
				Join Date: Aug 2006 Location: Sheboygan, WI 
					Posts: 2,582
				 
		 
		 
		
		 
		
		
	
		
	
	 | For me it was as Margerie said.  It was called a "bolus" (spelling?) and it was used every 3rd or 4th day as a way keeping the radiation from going too deep.  
 Mary Jo
 
				__________________ "Be still and know that I am God." Psalm 46:10 Dx. 6/24/05 age 45 Right Breast IDC ER/PR. Neg., - Her2+++ RB Mast. - 7/28/05 - 4 cm. tumor Margins clear - 1 microscopic cell 1 sent. node No Vasucular Invasion 4 DD A/C - 4 DD Taxol & Herceptin 1 full year of Herceptin received every 3 weeks 28 rads prophylactic Mast. 3/2/06 17 Years NED <>< Romans 8:28 
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		|  11-30-2007, 10:03 AM | #8 |  
	| Senior Member 
				 
				Join Date: Jun 2006 Location: San Antonio, TX 
					Posts: 2,357
				 
		 
		 
		
		 
		
		
	
		
	
	 | I had the bolus, "skin like stuff" every other or every third day!  Same reasons.  ma 
				__________________MA in TX.
 Grateful for each and every day....
 
 Diag. 12/05 at age 60
 Stage II, Grade 3, 4.5 cm primary tumor
 ER/PR- Her2 +3 strongly positive
 Her2 by FISH 7.7 amplified
 vascular invasion
 Ki67 20% borderline
 Jan - March '06 Taxotere/Adriamycin X 3 to try to shrink tumor - it grew
 April '06 Rt Modified Radical Mas, 7 of 9 nodes positive
 April - Aug. '06 Herceptin/Taxol/Carboplatin X 8 (dose dense)
 Sept - Dec. '06 Navelbine/Herceptin x 8 (dose dense)
 Radiation & Herceptin Jan. 22 - March 1, 2007
 Finished Herceptin Dec. 10 '08! One extra year.
 Port removed August, 2012.
 8 1/2 years since diagnosis! 5 1/2 Years NED!
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		|  11-30-2007, 06:59 PM | #9 |  
	| Senior Member 
				 
				Join Date: Apr 2007 Location: LA LA Land 
					Posts: 1,607
				 
		 
		 
		
		 
		
		
	
		
	
	 | 
				
				WOw-
			 
 I can't believe I had the exact opposite understanding of the gel pack.  Never knew a technical name for it.  I think I was just so stunned to be back in radiation land - 10 years later. 
 Brian with a "Y", big hunk, southern gent was my technician.  Maybe I was distracted but all this time I thought it was to protect my skin.  They were only trying to do a light zapping so who knows what really happened. lol.
 
				__________________1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
 2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda.  Finally stops spreading.
 2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
 ‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
 ‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
 1/2006 Rads again,  to scar line. NED.
 
 3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
 12/07 Herceptin.Tykerb. Markers go stable.
 2/8/08 gamma knife 13mm stupid brain met.
 3/08 Herceptin/tykerb/avastin/zometa.
 3/09 brain NED. Lungs STABLE.
 4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
 9/09 MARKERS normal!
 3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
 Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
 Dec 2010 Brain NED, lungs/sternum stable. markers normal.
 MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
 May-Aug 2011 Tykerb Herceptin Xgeva.
 Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
 April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
 OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
 12/20/12 add in PERJETA!
 March 2013 – 5 YEARS POST continue HAPZ
 APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
 May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
 June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
 Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
 Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
 December '13 BRAIN MRI ned in da head.
 Jan 2014: CONTINUING on HAPX…
 FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
 3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
 4. scattered lung nodules, up to 5mm in size = stable, no increased activity
 5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
 APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
 October 2014: hold avastin, continue HPX
 Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
 Continue HPX. Adding back Avastin
 Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
 December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
 Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX.  I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
 Markers drop post rads.
 2/24/16 HAP plus X - markers are down
 SCIATIC PAIN DEAL BREAKER.
 3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
 APRIL 2016 - 9 YRS MBC
 July 2016 - continue HAP plus Xgeva.
 DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad.  Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
 APRIL 2017 10 YEARS MBC
 December 2017 - Progression - gonna switch it up
 FEB 2018 - Kadcyla 3 cycles ---->progression :(
 MAY30th - bronchoscopy, w/foundation1 - her2 enriched
 Aug 27, 2018 - start clinical trial ZW25
 JAN 2019 - ZW25 seems to be keeping me stable
 APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
 MAY 2019 - progression back on herceptin add xeloda
 JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
 10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
 12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved  or improved results.  Markers near normal. I'm stunned but grateful.
 10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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		|  12-01-2007, 02:41 PM | #10 |  
	| Senior Member 
				 
				Join Date: Nov 2005 Location: Northern Calif. 
					Posts: 981
				 
		 
		 
		
		 
		
		
	
		
	
	 | I had the bolus used as well so the rads would be more concentrated to the area on my chest that had the skin met. It was used every other tx.
 Lexi
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