starting chemo after radiation

everetta

I am now finishing radiation and it is 11 weeks since my lumpectomy. (I had the lumpectomy less then 2 weeks after the biopsy). I could not decide on chemo but am now thinking I should have done it. Is is too late or can you have it after radiation (and how long to you need to wait in-between?). Will it still be effective starting it later?

AngieInAmsterdam

Hi Everetta,

I am currently undergoing chemotherapy AC-T. My lumpectomy was in September 2018. I had radiotherapy about 5 weeks after surgery. Just as I was beginning radiation, my MammaPrint results came back, and chemotherapy was necessary. I was 12 weeks post surgery when we began chemo. Your MO will be able to advise you regarding the recovery time between radiotherapy and beginning chemotherapy. Normally, chemotherapy is most effective within 90 days of surgery or 120 days of diagnosis. But definitely check with MO to help decide on what is best for you. Have you done a genomic test such as OncotypeDx or MammaPrint to help decide on the benefits of chemotherapy?

In my case, chemotherapy was part of my treatment path because of my MammaPrint results. I had also sought a 2nd opinion regarding MammaPrint results to confirm that chemo was necessary.

everetta

Hi AngieinAmsterdam/].

Mammoprint is used much more if Europe then in the US which uses oncotype. I did have a high -.203 mammoprint score but I had a low clinical score and therefore in the US when you have a low clinical score they do not use the mammoprint score. They do recommend it for people with a high clinical score.

Age makes a difference. My onctotype was done twice and I had a 27 and 31 high intermediate or low high. I am 68 so they are not recommending chemo but giving me the choice (1-3% benefit). I went ahead with radiation-4 weeks and will finish next week. I am not sure I am past the time chemo would be effective, but probably not but it is harder to get after radiation. Did you have any problems dong it in that direction?

May I ask your age range? They recommend chemo for people under 50 where they wouldn't for people over 50 since it is less effective.

AngieInAmsterdam

Hi Everetta,

I am 48. Yes, I believe under 50 my MO would most likely recommend chemotherapy even if my MammaPrint results came back somewhat lower.

Originally, my Breast surgeon who delivered the news of my diagnosis, said she didn’t think chemo was necessary. My tumor was 2.2 with no lymph involvement (stage II, grade 2) and BC subtype was ER+95%, PR+95%, HER-, hence; Lumpectomy with radiotherapy and then hormonal therapy would have been my treatment path. But I was adamant on a genomic test to see if chemotherapy would be necessary. And it came back high risk. I’m not sure if my age or any other factors came into play, but MO felt certain chemotherapy was to follow after radiotherapy. I asked for a 2nd opinion from Antoni van Leeuwenhoek hospital, which is the top cancer institute in the Netherlands, and the specialist confirmed that chemo was indeed the right decision.

Did your oncotype DX provide a TailorDX to help with intermediate score? I’m not familiar with oncotypeDX, but I thought I read that somewhere.

I’m not sure how much of a real percentage chemo would lower the risk factor for recurrence vs. the risk of not doing chemotherapy, but being quite fit and healthy and under 50, I concluded that perhaps this was the right choice for me.

As for chemo after radiation treatments, I asked RO if that was cause for concern, but she said that it’s not so much a factor. Radiotherapy is locally targeted and chemo is systematic (whole body). I began chemo almost 5 weeks after radiation, but that was due to waiting for 2nd opinion. I believe 2-3 weeks was the original start date. The only complaint of chemo after radiation is from my surgical site. Chemo may add further irritation/pain to an already beat up breast tissue trying to heal.

Not gonna lie, chemotherapy can be exhausting. Although, I’m managing through the side effects alright so far. Going to the gym at least once or twice a week really helps. I believe anyone who is active and relatively healthy regardless of age, would be able to handle chemotherapy. Though, that’s just an opinion. Your MO would be the best person to discuss benefits vs risks specifically for you. Everyone is different.

Hope I’ve been able to offer a little bit of insight.

everetta

HI Angie,

Thanks so much for your feedback It is very helpful. I hope you continue to do well with chemo. You have made all the right decisions and I hope you continue to do well.

Thanks for your insight.