The order of your treatment (lumpectomy -> chemo --> mastectomy)

minatabo

Hello all,

I've been putting a lot of thought into my treatment plan - I mean it might be a little too late, but just wondering if there are other ladies in the same boat as me.

I have bilateral BC - the surgeon suggested for double mastectomy, but I was not ready for that decision. I opted for lumpectomies , as a stepping stone to my mastectomies. (surgeon ok'd that, he said that would at least see the extensiveness of my disease - that way, later on I can do mastectomy followed by immediate reconstruction). Lumpectomies removed 4 tumors - 3 of which still had positive margins, but since i was going for mastectomies, he didn't go back for reexcision.

I started chemo shortly after, TC x4, before my mastectomy.

Now, would this be considered neoadjuvant chemo or adjuvant chemo knowing i still have uncleared tumors in me. Has anyone done is this way too? Or you went to remove everything + reconstruction before starting chemo?

Minatabo

MinusTwo

interesting question Minatabo. I wouldn't think the chemo would be called neo-adjuvant, but I really don't know.

I had BMX & reconstruction for DCIS so no other treatment. When I had a recurrence, it was IDC and HER2+, so I had neo-adjuvant chemo, ALND surgery, more chemo, rads & herceptin for the rest of a year.

SpecialK

minatabo - I think your lumpectomies were sort of excisional biopsies - whether they were intended to be complete lumpectomies or not, particularly in light of leaving the positive margins knowing that you would then have systemic treatment and more extensive surgery. I would actually regard your chemo as neoadjuvent because of this, but I think this approach is pretty uncommon. Did you have bi-lateral SNB with your initial surgery, or is that being left for the second surgery? I was treated prior to the advent of Perjeta for Her2+, so I received surgery first, then chemo. I did not have radiation because after the discovery of a positive SNB I had axillary clearance surgery five weeks after my bi-lateral mastectomy, and the rads were deemed unnecessary.

minatabo

Hello SpecialK,

I did have Bilateral SNB with that first surgery - SNB are out and 0/3.

I asked my surgeon about going back for reexcision - but he explained he removed most tumor masses (he couldn't et to the ones with positive margins because of the location) and since the plan is to hope for mastectomy + immediate reconstruction, doing this extensive surgery and waiting for recovery will miss me 'prime time' for chemo.

I've been reading other treatment plan others have - and yes, mines doesn't seem that common. It seemed to make sense during the discussion with my surgeon, but after putting more thoughts to it. I'm not sure. My MO calls it adjuvant chemo - but I'm wondering if the dose/type of medication would be different if it was technically suppose to be NEOadjuvant chemo.

SpecialK

minatabo - to my knowledge there is no dosing difference between neoadjuvent and adjuvant chemo, and the drug regimen choice is tailored to the specifics of the tumor(s), but not the order of treatment. I would have received the same regimen whether I had chemo prior to surgery, or after. Your advantage is that there is far less tumor burden for the systemic treatment to attack - which I would think is a good thing. Having surgery in this order may be the best of both worlds for you.