Trying to Make a decision on Radiation

Fox3

I was dx in 9/2017 with Right breast ILC, 4.5cm, stage 2b, grade 2, 1/3 sentinel nodes, ER+ PR+ Her2 -. I had a R Mastectomy, followed by 4 cycles of TC. I am on Tamoxifen everyday for 10years.

2 Radiation Oncologists are recommending 5 weeks

Plastic Surgeon says, no need for radiation, that the benefits do not out way the risks and that I could get a secondary CA from the rads, in addition to permanent side effects, including lymphadema.

Oncologist says, no need for radiation, that there are no studies that show any benefit in my case because the women that were studied did not get the new chemo out there, they were treated with CMF, less toxic chemo.

I have heard about a lot of negative and permanent side effects from it. I am Caucasian and have very thin skin, like you can see my surface veins everywhere. I am leaning towards not getting it but of course don't want a recurrence. I am struggling with this decision. Any advice is appreciated. I have gained so much from reading this forum. Thank you!

Mucki1991

plastics while well intentioned is not an MO... The MO is correct about the studies but I'd be cautious because they only 3 nodes checked. Yes rads can cause lymphedema but so can the removal of one node. A lot of us mastectomy ladies have really thin skin and some come out with damage and some don't . It's just luck sometimes. 4.5 cm is not exactly a small tumor. I'm a little on the younger side so I did it all not sure what your age is? I'm currently recovering from a biopsy so you never know. Look at it like this chemo covers distant cancer cells and rads covers local cancer cells. There is no way of knowing if a few cells remain with in the chest area or in lymph nodes that were not checked. For extra insurance I would and did do it but that's me.. I didn't go through chemoville just to have a recurrence because I wanted to skip rads.. Which I hated btw... I know it's a hard decision.. Best wishes for you

Runrcrb

I had cancer in 4/5 sentinel nodes. Low scores on oncotype/mammaprint. Radiation was always in my plan, chemo due to 4 lymph nodes. I too had TC chemo - so less chemo than many.

I have had some lymphadema issues but nothing anyone other than a lymphadema specialist and I could tell. And while it was post radiation, i think the trauma of breaking my arm immediately following radiation caused it (and never slowing down - so slow down). I feel more heaviness in my breast than in my arm and also think that having my surgeon go in and clean up the scar tissue from my sentinel node biopsy (in the plans) will allow for better drainage.

The good thing about being where you are is that you have choices. I would weigh the medical oncologist and radiation oncologist (understandably biased) opinions heavier than the plastic surgeon. Since you're on Tamoxifen, I assume you are younger than I (55 at diagnosis). You need to do what makes you comfortable - take some time to read up and draw your own conclusion. When you make a decision and you feel at peace, you will know it's the right one for you.

Good luck

Fox3

Thank you both for your responses. I am 53. Yes, lots to consider. I know my tumor was big (4.5cm). My oncotype was 20, so, intermediate. Thanks again for weighing in here, very helpful!

mommck3

I just came upon this post and I am in a similar situation.  age 42, IDC, Stage IIA, 3cm, Extensive LVI, grade 3, 0/2 sn, ER/PR+, HER2-, Oncotype 17.  I had double mastectomy and starting chemo on 6/27 (TC 4 cycles).  I got 2 opinions from top 10 ranked hospitals on rads.  One RO said rads not needed and chemo is going to kill anything left (the only cells that could remain are ones that were on skin layer?).  The other top RO said rads is needed due to age, grade 3 and extensive LVI, recommended 25 treatments and did not that there are reconstruction side effects.  I am very torn on what to do.  Breast surgeon didn't think I needed rads and thought it was over treating (since I am in grey zone on benefits of chemo).  I guess I need 3rd opinion now.  Any advice is greatly appreciated. 

Thank you

Janal123

I am in a similar situation. I am almost 75 with no family history of breast cancer. Diagnosed with DCIS in Feb., had a lumpectomy in April along with breast reconstruction. I was Stage 0, high grade with comedonecrosis. Large margin removed and one sentinel lobe biopsied- everything negative. I have a large area of necrosis which may improve a bit but won't go away by itself. If I have radiation I will have few options for future repair. I've looked at quite a few research articles and they pretty much say I will have a slightly higher risk of reoccurrence but , because of my age, longevity wasn't affected for either radiation or non radiation group. So, what to do? I'm leaning towards not having radiation. I'd be interested in hearing from those who chose radiation and those who didn't. Thank you

star2017

I was diagnosed around the same time as you were, and our stats are similar, tho I think my tumor was bigger and therefore my stage was 3a. I’m at the tail end of 6 weeks of radiation

star2017

mommck3, I had my implant placed before radiation. Is that an option for you?

muska

for what it’s worth, had strong chemo followed by radiation and have no lymphedema. My radiation was after implant exchange surgery and everything is fine.

Best to all