ALND or straight to chemo

Luah

Hi ladies: I posted over on the Surgery board, but as my concern is really linked to my Trip Neg status, I thought some of you would have some wise words or experiences to share...

I had 1/4 nodes positive (micromets) on SNB. Now I have to choose:  Do full ALND, then chemo, then rads. Or move straight to chemo followed by aggressive rads to level 1,2,3 nodes.  I am coming to terms with the risk of lymphedema (which will be amplified with ALND), but what's really driving me crazy is:  If I postpone chemo for 5-6 weeks (maybe more with complications) to  accommodate more surgery, am I risking the effectiveness of the only systemic weapon I have? Am I giving random cancer cells the chance to set up house in my liver or lungs....?

Surgeons all cite ALND as standard of care. Rad onco recommends no ALND, just aggressive rads.  And my medical onco cites 2006 study that starting chemo in < 4 weeks, 4-8 weeks, 8-12 weeks from primary surgery makes no difference in outcomes; outcomes are worse only when you get beyond 12 weeks. So I suppose I should feel assured. But I feel like I'm sitting on a time-bomb, with such a high grade cancer. 

cheranthia

Hi Luah,

I don't have an answer for you, but I find it interesting that surgeons want to cut and radiation oncologists want to do rads. What does your medical oncologist think? At least he doesn't have a horse in this race.  

Here is a link to a study that compares the effectiveness of RT and ALND. The participants were node negative and their hormone status was unknown, so their situation is not exactly the same as yours. Still, it is food for thought.

 http://www.ro-journal.com/content/2/1/40

Hope this is helpful! Best to you.

sftfemme65

I knew going in for my mastectomy that I had at least on positive node.  I had 20 nodes removed, 3 positive.  I then had chemo.  No rads.  I got that opinion from my onc and 2 rad oncs.  No rads if there is under 4 nodes. 

I can tell you that removing nodes is not the only thing that increases chance of lymphedema.  Rads to that area increases it by 75% according to the rads onc I saw. 

Teresa

Luah

Thanks ladies.  I decided to go ahead with the ALND, which my surgeon was able to do pretty immediately (2 days ago). Now waiting to see if and how many other nodes are involved. Fingers crossed. 

My onco sided with the 3 surgeons, citing "standard of care."  Still she said if I had to wait long for surgery, I could instead proceed with chemo, then go back to have the ALND.

For sure, I'm in  a grey zone with micromets on SNB; hopefully there'll be some widescale studies soon that will show one way or the other whether ALND is beneficial or not.

thenewme

Hi Luah! How did the surgery go?  How are you feeling? 

I have my fingers crossed for you too!  I'm so glad they were able to get you in so quickly!  So next step is chemo, then?  Do you know when that will start? 

Let us know what you find out, when you feel up to it!  Hang in there! 

Hugs!