Robes for Radiation

10/08/2026

This explains why each of us may have had different treatment. I had 35, but also still had positive pathology after chemo and node involvement.
Never heard it explained this was before.

5, 8, 10 OR 15 FRACTIONS?
WHY DOESN’T EVERY BREAST CANCER PATIENT GET THE SAME NUMBER OF SESSIONS?

When patients hear that one woman received 5 radiotherapy sessions, another received 15, and someone else received 8 or 10, it is natural to ask: “Why? Isn’t the treatment supposed to be the same?” The answer is that fractionation is not simply a matter of counting treatment visits. In radiotherapy, we are constantly balancing total dose, dose per fraction, treatment volume, tumor biology, normal-tissue tolerance, and the patient's individual clinical situation.

The classic approach to breast radiotherapy used 50 Gy in 25 fractions, delivering 2 Gy per fraction over approximately 5 weeks. Modern evidence demonstrated that breast cancer can be safely treated with larger doses per fraction, leading to moderate hypofractionation, such as 40 Gy in 15 fractions over 3 weeks or 42.5 Gy in 16 fractions. ASTRO guidelines have recognized 40 Gy/15 fractions and 42.5 Gy/16 fractions as established hypofractionated whole-breast schedules.

Then came a major change: ultrahypofractionation. The FAST-Forward trial compared 26 Gy in 5 fractions over 1 week with 40 Gy in 15 fractions and demonstrated that the 5-fraction schedule was non-inferior for local control at 5 years, with comparable normal-tissue effects in the studied population. This is why 5-fraction breast radiotherapy has become an important option for appropriately selected patients.

But here's the key physics concept: 26 Gy in 5 fractions is not simply “40 Gy divided into fewer days.” Each fraction is larger—5.2 Gy per fraction—and the biological effect depends on both total dose and fraction size. This is where radiobiology and the linear-quadratic model become important. We have to consider how tumor cells and late-responding normal tissues respond to different fraction sizes, rather than comparing total physical dose alone.

So why might one patient receive 5 fractions while another receives 15? The decision can depend on the treatment volume and clinical situation. Whole-breast or chest-wall treatment, regional nodal irradiation, partial-breast irradiation, reconstruction, tumor characteristics, age, anatomy, previous treatment and institutional protocols can all influence the appropriate fractionation. For example, ASTRO's partial-breast guideline includes 30 Gy in 5 fractions and 40.05 Gy in 15 fractions as external-beam partial-breast options for appropriately selected early-stage patients.

And yes—8 fractions can appear in breast radiotherapy too, but the context matters. Eight fractions are commonly encountered in some tumor-bed boost or partial-breast brachytherapy approaches rather than representing a universal whole-breast schedule. For example, a sequential boost of 16 Gy in 8 fractions has been used after whole-breast treatment, while GEC-ESTRO partial-breast brachytherapy schedules have included 32 Gy in 8 fractions.

The same principle explains why 10 fractions can appear in breast treatment. Depending on the technique and target, partial-breast irradiation may use regimens such as 38.5 Gy in 10 fractions, while other clinical protocols have investigated schedules such as 34 Gy in 10 fractions. These are not interchangeable with 10 fractions of whole-breast irradiation—the target volume and dose per fraction matter just as much as the number of fractions.

So when someone says, “She only received five sessions—does that mean her treatment was weaker?” the answer is no. Five fractions can represent a carefully designed, evidence-based radiotherapy regimen in the appropriate patient. Conversely, choosing 15 fractions is not necessarily “older” or “less advanced.” Sometimes the larger number of fractions is the more appropriate choice because of the patient's target volumes, nodal treatment, anatomy, reconstruction, risk factors, or the evidence supporting that particular clinical situation.

Fractionation is not about giving radiation for more days or fewer days.

It is about finding the right relationship between dose, fraction size, biology, tumor control and normal-tissue protection.

5 fractions.
8 fractions.
10 fractions.
15 fractions.

Different numbers—but behind every number, there is radiobiology, clinical evidence and a reason.

References

Brunt AM, et al. FAST-Forward Trial: 26 Gy or 27 Gy in 5 fractions vs 40 Gy in 15 fractions. Lancet Oncology / Health Technology Assessment.

Smith BD, et al. ASTRO Guideline on Radiation Therapy for the Whole Breast. Practical Radiation Oncology.

Meattini I, et al. ESTRO-ACROP consensus recommendations on dose and fractionation for early breast cancer. Lancet Oncology. 2022.

ASTRO. Clinical Practice Guideline: Partial Breast Irradiation. 2023/2024.

10/04/2026

Today’s nonprofit!

https://www.facebook.com/profile.php?id=61558197823343

Paint the Delaware Pink was started by a breast cancer survivor who wanted to share her love of and the healing power of the outdoors, River and fly fishing with fellow survivors. It’s a wonderful weekend in NE Pa absolutely free for breast cancer survivors of all stages. Relax and be spoiled, spend time on the River even if you’ve never fished before.

Sign up for next years event or if so inclined this is a fabulous place to donate that directly benefits survivors much like Robes for Radiation!

Paint The Delaware Pink is a 501(c)3 that hosts free fly fishing retreats on the banks of the Delaware River to those who have battled through breast cancer.

10/03/2026

Today’s share -

https://www.nationalbreastcancer.org/

Not only funds research but also many programs helping survivors along the way. Recognized and one of the leading BC nonprofits.

Know where your money goes.

National Breast Cancer Foundation provides early detection screenings, including mammograms, breast health education, and a supportive community.

10/02/2026

Alternate this wih the upper body program, two days a week each! 15 min easily done! Good for you, survival, reduce recurrence risk and bones!

A simple hips and inner-thigh workout for home. Five moves, three sets, and a mix of standing and floor exercises.

10/02/2026

As many of us here are well acquainted with the diagnosis. Sending light and love, and virtual “robe” hugz to all of you. 🩷

October is Breast Cancer Awareness Month. 🎀

This month, I’m sending so much love to:

🎀 The survivors
🎀 Those currently fighting
🎀 Those who were just diagnosed and are still trying to process the words “you have cancer”
🎀 Those living with metastatic breast cancer
🎀 Those we’ve lost far too soon
🎀 The families grieving someone they love
🎀 The caregivers who show up day after day
🎀 The friends, family members, medical teams, and supporters standing beside us
🎀 And everyone using their voice to spread awareness, advocate, fund research, and give others hope

Breast cancer is so much more than pink ribbons and one month on the calendar. Behind every ribbon is a person. A family. A story. A life forever changed.

So, this October, may every person affected by breast cancer be reminded:

We see you.
We honor you.
We stand beside you.
And we love you. 🎀🩷

Here’s to more awareness. More research. More early detection. More treatment options. And most of all, more survivors.

10/02/2026

I am going to try to add a bit more valid breast cancer treatment and survival information here in this page. Dr Teplinsky uses valid research to educate, and is a great source of information if you want to follow her page.

October 1st starts . This is a month that is hard for so many and so if you need to unplug, disconnect, unfollow for your mental health, please do so.

Breast cancer awareness month takes on a new level of consumerism every year. Companies want you to buy their pink product and throw it in your face with ads, marketing campaigns, endless emails etc. This month is more than that. Despite the fact that breast cancer is NOT a brand, the 🎀 probably has just as much (if not more) brand recognition than companies like Nike, Google and Apple.

We have attention and awareness but now we need ACTION and RESULTS. We NEED:
⭐️ Research for metastatic breast cancer
⭐️ Research for all people affected by breast cancer and for previvors.
⭐️ Research for prevention and early detection and risk reduction.
⭐️ Research into why breast cancer is on the rise, especially in people younger than 50
⭐️ Research to prevent recurrence from early stage breast cancer
⭐️ Research to improve quality of life for survivors and thrivers
(and more).

So where do we start?

I will be using my page and platform this month to share FACTS, dispel MYTHS, and educate on ACTIONS that we can all take to reduce our own risk and help others.

Breast cancer affects all people. Breast cancer does not discriminate. Breast cancer does not care about how much money you have. Breast cancer does not care about your status in life. Breast cancer affects EVERYONE. 💗

Follow along this month and share my page with someone who may find it helpful!

Coming later this week: Organizations and small businesses to support this month! (If you haven’t already told me who you support, this is a great time to do so ⬇️ in the comments).

🏷️📣👍 this post if it resonates with you 💗💗

10/02/2026

This is a great upper body workout! So many survivors on estrogen limiting meds, strength training is so important!

Upper-body workout at home with one resistance band. Five moves, three sets, no gym trip.

Save this for later.

08/14/2026

Good information. Movement is medicine and prevention.

New Substack is up about a new study evaluating body composition and impact on fracture risk and fracture progression in patients on aromatase inhibitors for breast cancer.

All details in Substack post but two key points from the study:

1. Higher body fat was linked to a higher risk of vertebral fractures. Women with excess body fat had more than twice the risk of developing or worsening vertebral fractures while taking an aromatase inhibitor, even after accounting for other fracture risk factors.

2. Muscle matters. Higher lean mass was independently associated with a lower risk of vertebral fracture progression.

If you want more info on bone and muscle health after breast cancer, I have a whole chapter in my book, Beyond the Pink, on the topic. Pre-order now! (Less than 7 weeks until it’s out!).

Substack: https://open.substack.com/pub/drteplinsky/p/aromatase-inhibitors-body-fat-and?r=645vr&utm_medium=ios

Pre-order the book on Amazon: https://a.co/d/01DHfIEF
(Or anywhere you buy books!)

Let me know all your questions about musculoskeletal health and cancer!

07/30/2026

I pray this is information no one should ever need but it’s a very important consideration, and if there is one thing I would possibly do differently it’s this. I agree with that 40% dissatisfaction number, probably higher. And I’ve met women that have had so many revisions it’s crazy. The risk of revision especially after radiation is very high and something I won’t risk but some days……my biggest advice if you are diagnosed, take your time on if and what kind of reconstruction you may do. I thought I had researched enough.

Many studies show that breast reconstruction improves breast-cancer patients’ overall mental health. Yet many patients say they felt underprepared by their doctors for the length and intensity of the breast-reconstruction process. Up to 40 percent of women who undergo breast reconstruction end up dissatisfied with the results.

“To me, the risk of a complication is the Achilles’ heel of breast reconstruction. It’s a really important operation. It has the potential to restore quality of life,” said Dr. Clara Lee, a plastic surgeon and professor. “But there’s this relatively high complication risk.” For some women with breast cancer, that complication risk means undergoing multiple unplanned surgeries in pursuit of rebuilding the breasts they lost to cancer. And even if everything goes well, with minimal or even zero complications, almost all breast reconstructions will involve multiple “revision” operations.

What drives some women to persist through so many years of so many surgeries? It’s difficult to understand unless you’re in it, and many of the women Melissa Dahl spoke to found it hard to articulate. “Where it gets hard,” said Dr. Monique C. James, a psychiatrist who works with patients undergoing mastectomy and reconstruction, “is when people have assigned meanings to their breasts that connect to their identity.” She starts her relationship with her patients by asking each one the same question: “What do your breasts mean to you?” Just like breast reconstruction, the question is often more complicated than it seems.

Dahl reports on the complication-riddled process of breast reconstruction: https://nymag.visitlink.me/pcEAWK

07/28/2026

Hey all! Fabulous news! I just dropped off boxes of robes for McGlinn Cancer Center in Phoenixville for their center and Pottstown! My apologies, I intended a cute selfie to celebrate and show you all what we did! The department manager was more than happy to resume the program. There was no communication when previous staff left and they were not aware of the program. I will get a better photo next time!