.5mm margin?

GoodConstitution

.5mm margin?

GoodConstitution

I'm wondering how many of you have proceeded with radiation with a margin like this. I am getting very mixed messages from surgeons. Thanks to all who are so kind to take the time to give feedback!

Nancy2581

one of my margins was only .8mm. It was considered clear. I moved on to treatment.

Nancy

slv58

My closest margin was 4 mm chest wall. I've already had radiation but was assured this was acceptable. Apparently the thinking is that as long as there is no ink you are good. I feel uneasy and wish the margin was larger but have to have faith

GoodConstitution

Hi Slv,

Thanks for your feedback. How are you feeling since your mastectomy? It looks like you had chemo,lumpectomy, radiation, chemo and mastectomy. Was the .4mm margin for the lumpectomy! I'm hope this finds you with peace and feeling well!

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GoodConstitution

Hi Nancy,

Thanks for your feedback! How was your experience with your treatments....radiation, tamoxifen, chemo? I'm in the Northwest and am experiencing different treatments based on where one lives. I wish you strength, peace and health!

slv58

Hi GoodConstituion, thank you for good wishes. My mastectomy was due to a local recurrence after lumpectomy (with good margins -my closest was 1.3 cm) and neoadjuvent chemo. 17 months post tx I found a lump under scar and recurrence was confirmed. It was thought that there was skin and muscle invasion from MRI but I was grateful to learn that although close it had not invaded. 4mm was my closest margin to muscle. Because I already did radiation and my margin is considered "good" I can not have radiation again, although my RO said that had it invaded muscle or skin, he would radiate again.

I am now doing 6 tx of cisplatin and Gemcitabine - praying this gets rid of every microscopic cell there is especially since I achieved PCR the first time! My MO says it is extremely rare to have a local recurrence after PCR but unfortunately it can happen.

I think it depends on your pathology and how aggressive it is. I have a very aggressive tumour and decided very early on that if I didn't do absolutely everything to get rid of this I could never live with the "what ifs". I did high dose chemo (vs. dose dense) had very good margins from LX and did 33 radiation tx to whole breast, axilla and supraclavicular and yet it came back. I'm at peace knowing I've done everything but you have to weigh your own circumstances. Best wishes in your decision.

knittingPT

So the ASTRO and SSO (radiation oncology society and surgical oncology society) released a consensus report on size of margins. I am copying their list of 8 recommendations here. Basically, they say that negative margins of any size are enough. Bigger margins do not lead to better outcomes. I hope this will put you at ease.

"The consensus guideline includes eight clinical practice recommendations:

1) positive margins, defined as ink on invasive cancer or DCIS, are associated with at least a two-fold increase in IBTR. This increased risk is not nullified by delivery of a boost, delivery of systemic therapy or favorable biology;

2) negative margins (no ink on tumor) optimize IBTR. Wider margin widths do not significantly lower this risk;

3) the rates of IBTR are reduced with the use of systemic therapy. In the event that a patient does not receive adjuvant systemic therapy, there is no evidence suggesting that margins wider than no ink on tumor are needed;

4) margins wider than no ink on tumor are not indicated based on biologic subtype;

5) the choice of whole-breast irradiation delivery technique, fractionation and boost dose should not be dependent on margin width;

6) wider negative margins than no ink on tumor are not indicated for invasive lobular cancer. Classic lobular carcinoma in situ (LCIS) at the margin is not an indication for re-excision. The significance of pleomorphic LCIS at the margin is uncertain;

7) young age (≤40 years) is associated with both an increased risk of IBTR after breast-conserving therapy (BCT) and an increased risk of local relapse on the chest wall after mastectomy and is more frequently associated with adverse biologic and pathologic features. There is no evidence that increased margin width nullifies the increased risk of IBTR in young patients; and

8) an extensive intraductal component (EIC) identifies patients who may have a large residual DCIS burden after lumpectomy. There is no evidence of an association between increased risk of IBTR and EIC when margins are negative"

Hopeful82014

That's very helpful, KPT. Thank you.

GoodConstitution

Very succinct! All that makes me wonder why all the radiation oncologists and oncologists in the Northwest are holding tight to 2mm margins. Thanks for the feedback Knitting PT! I hope you're well!

Hopeful82014

Good Constitution - count your blessings. I'm in Oregon and my bs holds out for 5mm margins. We'll see if she got them...

Nancy2581

hopeful, did you have your surgery? I know it was coming up

Goodconstituition - I was lucky with my treatments. I really didn't have any problems on chemo. I did have a few burns from radiation , but they didn't hurt and healed quickly. I'm on tamoxifen now and the only side effects I have are hot flashes.

Nancy

Hopeful82014

Hi, Nancy - yes, finally had surgery this Wednesday. Lx and SNB, which turned out to be 4 nodes. The frozen section looked o.k. but we haven't seen the final pathology yet. Probably won't 'til next week. I'm doing o.k. but hate the pessimism and depression (and crankiness) that results from anesthesia.

My tumor was so close to the chest wall - I hope she was able to get good margins as well as hoping that the node really had cleared. I'm not really letting myself hope yet. Probably contributes to the crankiness...

How are you doing?

Nancy2581

Oh I'm glad you had the surgery and that's over with. Yes I think the waiting is just awful. It does change your mood. I'm keeping my fingers crossed for the best possible outcome for you. Hope recovery goes smoothly and quickly for you too.

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Nancy

Hopeful82014

Thanks so much, Nancy. I'll keep you posted.

Have a lovely weekend.

PoohBear-61

Article about close margins attached (its very helpful). I had a 0.4mm margin and it was considered clear .

https://www.breastcancer.org/research-news/20140402

Lolis197138

My margins were 0.1mm anterior and 0.3mm posterior and they were considered clear (even though I had a mastectomy). 

GoodConstitution

Hi Hopeful,

Up here they don't do frozen sections so I had three lumpectomies and mt surgeon is still telling me .5 mm margin isn't what she likes.

I'm glad you're surgery is over and you had a chance to have some indication with the frozen section. My surgeon said there was no indication for me that a sentinole node needed to be checked?

I'm getting a second opinion before moving forward but overwhelmed by the financial burden!

I hope this finds you feeling better. I didn't have general anesthesia so the recovery was quick for me!

Blessings to you!

PoohBear-61

Hi Ladies .....4 more good articles about close margins ...for those interested ?

http://thecancermd.com/2012/02/01/second-breast-cancer-surgery-required-for-positive-margins/  
http://www.nytimes.com/2012/02/01/health/repeat-breast-cancer-surgery-guidelines-found-unclear.html?_r=0
 
http://www.cancerworld.org/pdf/9184_pagina_12-16_Cutting_Edge.pdf

http://www.cap.org/apps/cap.portaL?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2F1012%2F1012b_lumpectomy_surgical.html&_state=maximized&_pageLabel=cntvwr

 

Hopeful82014

Thanks for your well wishes, GC. In the case of DCIS I don't think they usually check nodes, luckily for you. In my case we've known about at least one bad node all along so I am lucky to get off with SNB instead of full dissection. I gear you on the medical expenses; it's truly adding insult to injury, to say nothing of a heck of a lot of stress, isn't it?

I'm glad you didn't have general anesthesia. I could have done it with conscious sedation if not for the nodes and certainly would have.

Hopeful82014

Thanks for all the links, PoohBear! There is a lot of useful and interesting material in there.

GoodConstitution

Hi Hopeful,

I hope you're feeling better and have a chance to take a nice walk in the sunshine to decompress. I'll be praying for good results for you.

GoodConstitution

OH My Pooh Bear,

I read everyone of those articles and more! What I conclude is that it's not all about margins but also grade of DCIS and other histology. I read some support for my surgeon's suggestion for a better than .5mm margin and even more that suggests it MAY not be helpful. I also learned that margins are more predictable for invasive breast cancer because DCIS skips around.

I don't know how you found all that but THANK YOU! It was interesting! Still dazed and confused!

GoodConstitution

Hi Pooh Bear,

This information supports my surgeon's worry about the .5mm margin. There is .5cm from re excision site to chest wall. She is worried about the 4th lumpectomy leaving me dissatisfied cosmetically being only a B cup and has referred me to a plastic surgeon to talk about mastectomy options. I'm not sure a mastectomy is cosmetically acceptable to me either if we are just talking about cosmetic outcome with the same survival rate, especially considering the recovery of a mastectomy.

This is an excerpt from the Cancer World Report:

In cases of ductal carcinoma in situ (DCIS), however, a minimum clear margin of 2 mm is recommended, particularly with low- and interme- diate-grade lesions, because DCIS may grow discontinuously within the

ducts.

I Anterior and posterior margins of

less than 2 mm are not of concern

if there is no residual breast tissue. I All suspicious microcalcifications associated with the DCIS should

be removed surgically.

http://www.cancerworld.org/pdf/9184_pagina_12-16_Cutting_Edge.pdf

Hopeful82014

Thanks so much, Good Constitution! I hope you got to enjoy the sun, too. looks like a cooler, cloudier day here but still pretty good for this time of the year. Good luck with figuring it all out. Be sure to ask about a nipple sparing mastectomy, if mastectomy is, indeed, your best option.

GoodConstitution

Thanks again! I asked about nipple sparing but the surgeon is concerned that since that is basically where my lesion started that there is too much damage to the nipple for the blood supply to TAKE. She can do a skin sparing. I will meet with a plastic surgeon as she suggests because he will be able to share more and if he can repair damage from a possible 4th lumpectomy.

Happy Mother's Day!