Anyone opt out of radiation with MX?

christina1961

I went to see another surgeon today to get another opinion.  I am going through neoadjuvant chemo right now - the tumor has shrunk quite a bit- it was originally 2.6 x 2 cm.  The surgeon does not recommend implants following radiation at all.  I'm not sure of my node status but it is likely that I have one or two nodes that were positive - there are no longer any palpable nodes but one was enlarged after the biopsy (1 cm in size then)-although just three weeks before the ultrasound and MRI showed no positive nodes.  He thought I could go with an MX with no radiation - unless they found positive nodes during surgery in which case I would need radiation.  Anyone out there decide not to get radiation with a MX? 

bdavis

I think you only get radiation if you have more than 2 or 4 nodes.. I had one micromet and will NOT get rads with MX

Babs37

Christina- I had a mastectomy with 2/7 nodes positive. My doctor recommanded rads on mastectomy site and armpit.

christine47

Christina,  I had mastctomy with one positive node only. No rads for me, breast surgeon, onc, and radiation oncologist all agree.

NHsmiles

Hi Christina,

I had BMX and have chosen not to have radiation.  My breast surgeon made sure my margins were clean during my auxillary dissection. I had 3 positive nodes.

I have had serious rare complications from chemo, and I am unwilling to acquire damage to my heart and lungs from radition.

Heather 

dlb823

Christina, I think each of our situations is very individual. Factors like what kind of margins you have with your mast, your bc grade, and even the aggressiveness of some types of bc might be reasons why it might be wise for some to do rads even with a mast (I did), while others may not have the same concerns. The benefit of rads should be considered based on your stats  -- not influenced by what someone else with a mast (who most likely had different stats, margins, etc.) chose to do.  Hope this makes sense.   Deanna 

christina1961

Thanks, Deanna and everyone.  You are correct, Deanna -and I do understand what you are saying. I posted this in the triple negative area because I wanted to see what others, particularly with triple negative BC had opted for in terms of radiation following MX.  I think most of us will be grade 3 - I am- and most likely  basal subtype, too, according to my oncologist.  I thought radiation was almost always a part of treatment for triple negative BC and was surprised today when the surgeon mentioned MX without radiation as an option provided I do not have too many positive lymph nodes.  I still have the option of BCT with radiation, too, but the surgeon favors the MX without radiation because it avoids the potential complications of radiation.

poptart

I had radiation, even though i had negative nodes(13) and no lymphvas invasion at surgery and before chemo. I had a 1mm margin near some extensive dcis and had boosts for that. I also had lots of radiation to im field, axilla and chest wall. I think they thouht I was at higher risk for a local recurrence, so prehaps that is why all te rads. I had delayed reconstruction with expanders after my second mastectomy. I am prety small since I couldn't be expanded much after the rads - 350s for expanders. I had high grade triple negative

poptart

http://www.abstracts2view.com/sabcs09/view.php?nu=SABCS09L_2058&terms=

I don't know how relevant this is, but it does show that doing everything leads to better outcomes.

Luah

poptart: Thanks for posting that. I think it's the first time I've seen some definitive RFS stats for TN. I watched a webcast the other day about a new drug trial for TN and the lead doc on that was saying (just) 60% of TN women do "well" with conventional treatment. I am not sure how many years out he was talking about, but an 86% stat 5 years out sounds much better to me! 

christina1961

Thanks, Poptart!  Hmmm...hard to interpret some of this stuff: does that mean if radiation is not recommended for MX with less than 3 nodes positive as a standard of care then there would be no "violation" of conventional treatment? Or does it mean do radiation even if not used as the standard of care?  I'm leaning toward radiation.

I'

poptart

Luah,

Did you see this one?

http://www.abstracts2view.com/sabcs09/viewp.php?nu=p4044

It compares relapse risk between hormone positive and tnbc for early stage bc (stage 1 and 2 I think).  Similar statistic 85% relapse free.   The risk is high really early then drops dramatically.  I am sure if you looked at the same people 10 years out the numbers between hormone positive and triple negative would be closer.  Of course, in either case the stats should be better for people diagnosed at an early stage, either hormone negative or positive.  I think the 60% is for all cases of tnbc.

minxie

My situation was a little unusual - but I ended up not completing the full round of radiation, only doing one week. I'd had a lumpectomy in Dec, started chemo Jan, finished June, started my rads and that first week of rads had a follow up 6 month mammo - which found suspicious calcifications in the bad breast!!! They did an immediate biopsy and it was DCIS. As soon as I got the results we scheduled a double mastectomy. I asked my oncologist what to do about the radiation. After consulting with the radiologist, they both said I could skip the remaining radiation treatments. The two positive lymph nodes I had were very small micromets and they seemed to think it wouldbe OK. In some ways I wish I'd finished the rads so I could be sure I hit it with everything. But the mastectomy + reconstruction left me in rough shape and I so wanted to be done.

poptart

Thanks, Poptart!  Hmmm...hard to interpret some of this stuff: does that mean if radiation is not recommended for MX with less than 3 nodes positive as a standard of care then there would be no "violation" of conventional treatment? Or does it mean do radiation even if not used as the standard of care?  I'm leaning toward radiation.

I know it is hard to interpret.  I think some radiation is standard of care for a close margin (which I had), but I had a lot of radiation.  I had 0 postive nodes before chemo and they still did my im field and axilla.  I am okay with it.  I asked to have the maximum possible treatment.  Is radiaiton for 3 or more nodes what is considered standard? 

sanbar8771

I had 2 nodes that were positive and had clear margins when I had lumpectomy. I opted out of radiation. I had IDC in the left breast, and DCIS on the right. Thank god I have honest radiologists who told me straight up they do not like to radiate both breasts and to have a MX. I chose the MX and never been happier.

poptart

I had 2 nodes that were positive and had clear margins when I had lumpectomy. I opted out of radiation. I had IDC in the left breast, and DCIS on the right. Thank god I have honest radiologists who told me straight up they do not like to radiate both breasts and to have a MX. I chose the MX and never been happier.

Are you able to take tamoxifen?  With triple negative bc, there are no other treatment options besides chemotherapy and radiation.  I think the treatment recommendation might be different for triple negative since it has fewer treatment options. 

sanbar8771

I am not triple neg, but I am on tamoxifen. I am also on a monthly shot of zoladex. I saw the post and didnt realize I was on triple neg. Take Care all.

christina1961

Poptart,

I think I read that the standard of care was MX without radiation for 3 nodes and under, and radiation for 3 nodes positive plus.  But I am in the midst of chemo brain right now, having had chemo last Monday!  I have got to get busy and read all I can fast because I need to make a decision soon.  I wish I could feel comfortable just getting a MX without radiation, but I'm afraid to skip the radiation. The surgeons I've talked to have been extremely negative about implant reconstruction following radiation - which is what I want.  I may just end up doing a lumpectomy with radiation instead but it probably will not be very good cosmetic results due to my small breast size.

Claire_in_Seattle

Christina.....I had an absolutely fine cosmetic result with a lumpectomy.  In fact, I am thrilled.  No, not quite the same size, but not off by much either.

Your body will do a lot of its own "cosmetic surgery"......fill in with fat.  Good luck.

christina1961

Claire,

Thanks!  I'm so indecisive at this point but I'm going to talk to another PS soon about tissue expanders and implants following rads.  I was about an A cup before implants but my cancer affected breast was the larger breast to begin with - at this point, the remaining tumor by clinical exam is less than .5 mm - the doctor expects it will disappear completely by the end of chemo which I imagine would make the lumpectomy incision smaller - it just seems like the lumpectomy would be easier to recover from and I would still get the radiation that I want.  I wish they could leave the implants in, but no one has been very positive about that.  I think in ten years there will be a lot more experience with implants and breast cancer because they have become more common and those who have them will be getting into the higher risk ages for breast cancer.