Is Radiation Therapy needed?

LittleMom32

I’m trying to get my head around why I need radiation therapy when my surgery showed no cancer. Chemo from Sept-Dec 2019 which shrunk my 39mm tumor to 1.5mm and the two right sentinel lymph nodes from 14mm & 11mm to nothing. I had a double mastectomy.

I keep getting told that radiation is part of the cancer treatment. My pathology report reads “No evidence of Malignancy” in both of my breast and both lymph nodes. I had a Bone scan when I was first diagnosed and it stated the radiotracer was at the soft tissue of my right breast.

Why do I need radiation to kill the healthy tissue and cells that I have left?? There is nothing to show metastasis, and I’m still doing hormone therapy too.

Moderators

Hi LittleMom,

While you wait for the ever-helpful responses from our other members about their experiences, you may find it helpful to read the main Breastcancer.org site's page on When Is Radiation Therapy Appropriate? to better help understand why your doctors may be suggesting this additional treatment.

We hope this helps!

RatherBeSailing

LittleMom -

I'm a little confused. You had chemo before surgery? And you had a little residual disease in the breast of 1.5mm, or a complete response?

Post-mastectomy radiation (PMRT) is becoming more common, and recommendations are based on pre-chemo status. So even if you had a great response to neo-adjuvant chemo, if you were originally node positive they would still likely recommend radiation. ASCO/ASTRO guidelines from 2016 state: "... available evidence shows that PMRT reduces the risks of locoregional failure (LRF), any recurrence, and breast cancer mortality for patients with T1-2 breast cancer with one to three positive axillary nodes." That may be what the recommendation is based on.

Why don't you ask you radiation oncologist why s/he is recommending PMRT? Aside from pathology, what other factors make them think you need it? HER2 status? Your age? Grade 3? Although stats are only stats, they should be able to give you estimated recurrence rates with and without radiation. Usually they quote local regional recurrence, which includes your breast and local nodes (radiation is only local control.)

LittleMom32

I had chemo first because my tumor was 39mm and they found 2 axillary nodes (11mm). My oncologist wanted to shrink the tumor before surgery, and it worked very well. I was also getting Hormone therapy with the chemo as I’m triple positive.

During surgery is when they found residual in my breast and both nodes were clean. During surgery they twice injected two blue dyes near my nipple to watch where it went through my lymph nodes and it came back negative.

I was wondering if anyone else started chemo had surgery which came back with no cancerdidn’t get radiation.

HeartShapedBox

Im confused as well... you said they found 1.5mm of "residual" in your breast after neoadjuvant chemo, which means there was still cancer, not a pathological complete response. But your understanding is that there was no cancer found at surgery? It sounds like you need to clarify with your team.

Regardless, even if you DID have a complete response/ no cancer at surgery, the fact that you had cancer in your nodes (and HER2 positive cancer, at that) is the reason why they recommended radiation. I had cancer in my nodes, and did NOT have a complete response, but was told that even if I did get one, radiation would still be part of my treatment. The reasoning (I believe) is making sure they "mop up" any stray cells or small tumors that could be in other remaining nodes (but too small to show up on scans). And ESPECIALLY if you has residual cancer in your breast, it's proof the neoadjuvant chemo didn't kill everything, and the extra precaution of radiation is one more adjuvant safeguard.

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gb2115

Probably because even if pathology showed nothing left, they can't guarantee every tumor cell is gone. They can't biopsy all of you. Radiation would essentially clean up whatever could be left in the area. Think of it like this....chemo and surgery is scrubbing the counter with dish soap after getting raw chicken on it. There could still be a few germs left so you sanitize with a Lysol wipe. Radiation would be a Lysol wipe.

HeartShapedBox

Great analogy gb! Surgery is like removing the raw chicken from the counter, chemo is like wiping the germy counter with a wet rag, and radiation is like the disinfecting wipe after! 😆

In women who had a mastectomy but no positive nodes radiation hasn't been shown add any additional benefit. But when cancer has spread to nodes, even if neoadjuvant chemo "removed" the cancer from nodes, radiation still shows added benefit in reducing chance of recurrence.