Help! Very torn about radiotherapy decision

lemonadehk

Hi all, I am seeking some help in deciding radiotherapy. I have been torturing myself over this for the past couple of weeks, can't sleep well and eat well. Need to decide asap since it's been 5 weeks PFC.

I am 36, BRCA2+, stage 1B with 1 micrometastasis in 1 sentinel node, multifocal (12 rumors and the biggest is 4mm), mastectomy with level 1&2 dissection, then had AC-T for chemo. I saw quite a few ROs and the majorty said I don't need it, but my attending RO is leaning towards doing it. The reasons for not doing it are (1) my biggest tumor is only 4mm, and (2) the positive LN is a micro (<2mm); reasons for doing it include: (1) my age (2) multifocal nature of the tumor, (3) the pathology report did not report some accidentally discovered LCIS cells in a random block of issue.

I want to throw everything at this cancer, but scared of the long term effect of rads (lung damage, second malignancy etc., mine is on the right, so minimum heart damage). The fact that the majority ROs said the benefit is minimal also makes me hesitant, although my husband said my primary RO is the one who knows my case the best and I should trust him.

Would greatly appreciate your input!

dlb823

That's a tough one, but I think if I was in your situation I would be inclined to do the RT based on the fact that 12 (if that's not a typo) tumors is not a common scenario, and if at least some of them were grade 3 -- even though the positive node was only a micromet -- you have a bc that clearly is a bit unique, which might (not sure) also translate to more aggressive. At least, that's how I'm looking at it. Although they no longer add up the mms to suggest total tumor burden, I just feel like the fact that you had 12 separate malignant areas might be more of a risk than your possibly exaggerated fear of lung damage or a secondary malignancy.

I also dreaded the idea of RT, suggested in my case because of a sentinel node with extracapsular extension, as well as an unspecified margin. I also got multiple opinions (trying to get out of it), but what pursuaded me was the tone of the most "pro RT" one, a highly respected professor of RT, who said I needed it without question -- even though others had said it was my choice. And in the end, it was no big deal -- in fact, I would call it a piece of cake compared to surgery and chemo.

Just my opinion, although I'm sure others may see it differently...