Radiation necessary for isolated tumor cells?

meganbr

I was diagnosed in September, ER+/PR+ HER2+, so started with chemotherapy. It worked great, I had a 95% shrinkage in a 3.1 tumor (starting size). We never suspected any lymph node involvement. A unilateral masectomy in early April identified 3 sentinel lymph nodes. Two in the axillary region were clear but one intramammary node showed .18mm of isolated tumor cells. This is under the .2mm minimum measurement to be considered node positive. I also did not show signs of lymphovascular invasion. So now I am being presented with a choice whether or not to do radiation on the chest wall and all lymph nodes. The doctors have not recommended one path over another, they have just told me about the potential pros and cons of each choice. The RO says two factors which contribute to a thought I might want to do it are my age ((44), since younger women apparently respond even better to radiation?) and the fact that these cells were still there after chemotherapy. I was pursuing implant-based reconstruction, which would be made quite a bit more difficult after radiation to that area. I've heard horror stories. And it would obviously push back my exchange surgery by many months. It's a scary choice! I can have proton beam radiation at Mayo in Minnesota which is less than two hours from my house but it will still be quite inconvenient as I'm a mom of 3 active daughters and scheduling for proton beam can have you at almost any hour of the day (with a schedule released only at the beginning of each week, one week at a time). Makes planning difficult! I'm just wondering if anyone else has been in the same boat with isolated tumor cells and, if so, what did your team recommend and what did you decide? Will radiation do me more harm than good? Or will not doing it compound the worry I'll already have about recurrence? I have talked with three different doctors about this. One RO leaned toward radiation and the other two, an RO at Mayo and my main MO, are completely on the fence. There is no research or data that they are aware of to draw on for making a recommendation.

Walden1

Meaganbr: I am in a very similar situation. My RO said I’m also in a grey area but is recommending radiation after mastectomy because of my age and residual cancer (response not quite as good as yours). I have no nodes, no lymphovascular invasion, but two 2cm tumors with some DCIS and 5-15% of IDC remaining. I asked my RO to take this to a “conference”: that’s where she discusses the case with 5-6 other RO from the same hospital. Basically it gives me a second opinion. I will have the same concerns as you but I’m leaning toward doing it, so I don’t regret it later. Hope to hear from others in our situation

gb2115

I had a small amount in one node, but a little more than you. I think 2.1 mm. I had radiation to all nodes and do not regret it. I wanted to do everything I could to kill as many cancer cells as possible, because cells in a node indicate the cancer was on the move. And even though the other 2 nodes they checked were clear, I didn't see that as a guarantee.

ctmbsikia

Just reading your post the 2 things that would point me towards doing radiation would be 1-your age and 2-The nodes still being identified however microscopic, at surgery, after chemo, and being Her2 positive.  Best wishes to you, I know it's a royal pain and will mess up your reconstruction surgery(s).  Sounds like you have good Docs.  Last point is although there are horror stories out here, I believe them to be in the minority not the majority.  Just my opinion, not intended for any recommendation what so ever.

Hopeful82014

I would have to agree with those recommending radiation,despite the scheduling challenges. (Maybe some of those people who offered help when you were first dx. could step up again?)

I had a macromet and ITC and did supraclavicular RT as well as the usual. I thought I would be a crispy critter but that was by no means the case and my skin did very well. It's not something I would want to go through again but I'm glad it was available.

If you do opt for it, start taking care of your skin TODAY; stay out of the sun and religiously moisturize that size front, back, side and neck. The better condition your skin is going into RT, the better it holds up. One of the radiation nurses (who had been through it herself) gave me that piece of advice and I think it helped a lot. Good luck with your decision and any further treatment.