Radiation or no? It's "up to me" according to the RO

OnlyGirlof5

Here are the facts. I am sorting through them. I lean towards no, as the risks seem to outweigh the benefits. But I am on the fence.

My hormone status, Dx, etc are in my signature so I'm not repeating those here.

Additional pertinent info:

• The largest mass (ICD 3cm) and 1.0 cm mass was located behind the nipple and on the superior edge of the clear margin. Additional skin was removed for this reason
• The 3^rd mass (.8cm DCIS) was also in the upper quadrant and indicated in pathology as 1.7 cm from the posterior margin
• I have silicone implants (left removed at surgery) placed behind the muscle
• 1/3 nodes were found positive but microscopically
• EE present in the positive node (see below about RO's comments)
• Oncotype score was 4 so no chemo
• Started Tamoxifen last week
• Premenopausal, no plans to suppress ovaries at this time (but not off the table)
• If I choose radiation:
• Treatment would be whole breast for 5-6 weeks
• Possible complications/risks are given as possible damage to heart, lung, and ribs
• Potential complications affecting the reconstruction outcomes: infection, capsular contracture, infection leading to need for TE removal (additional surgeries), compromised skin and/or surgical scar which could lead to impairment to the final reconstruction outcome
• COVID delays start of treatment for ~1-2 months (this delays final reconstruction to ~6 months after radiation is complete)

RO's rationale:

• Oncotype score
• ER/PR+ with Tamoxifen likely to be more effective
• 3 weeks of radiation is an option RO would consider due to pandemic and for my concerns of complications to future reconstruction
• Risks appear to outweigh the benefits offered

My on-the-fence considerations:

• EE present – does this increase chance of spread? RO indicates with clear margins for the node removal, microscopic levels, and only 1/3 nodes affected. She has little to no concern as this may be more the biologic makeup of my cancer vs. an indication of future spread
• Potential for spread to my chest wall or other nodes – all masses were found in superior margins. Also I wonder if my former implant may have isolated the potential for spread to my chest wall (?)

I don't have to make a decision any time soon, since they will not start treatment until after the COVID threat dies down here in Michigan

edj3

I chose radiation because I was very much not a fan of tamoxifen (although I did try it). My cancer was also on the left side for what that's worth.

JRNJ

onlygirl, you already know my goal is to be aggressive per our chemo discussion. I started radiation on 3/30 for 7 weeks. My RO never once suggested delay. My surgery was 9/24/19, so I really don't want to delay it any further. NJ is ranked second for the virus. My center is part of a hospital but in it's own building. I'm wearing a mask and washing my hands often. But my tissue expanders were removed in October due to infection, so I am fully healed. So while I wouldn't be afraid of radiation, I would be more concerned with being admitted into the hospital for emergency surgery, as that is where I think I got the infection. But hope that wouldn't happen to you. I don't know what the odds are.

OnlyGirlof5

edj, I've never heard of radiation taking the place of meds (?). I have been told through this whole process that long term meds are my overall best option for reducing recurrence in the long run.

I'm a bit confused with your signature. It says you had radiation in June and Tamoxifen in September. Did you take T somewhere before radiation in order to determine radiation over T?

OnlyGirlof5

JRNJ - thanks for chiming in. I asked about starting sooner, if I decide to go forward. The RO said they are starting new cases during the pandemic but not for cases that can wait, and mine is a case that can. She says the risk for contracting the virus far outweighs any risk for delaying start of radiation.

Salamandra

Radiation really does reduce the risk of local recurrence - which would mess with reconstruction/implants all over again, plus increase risk of metastasis.

Another consideration that many doctors don't think of is health insurance/employment. If your health insurance/sick benefits are likely to be worse down the road than it is now, that again makes a local recurrence a worse outcome than it otherwise might be.

In your shoes, I *think* I wouldn't forgo radiation unless I got a concurring second opinion from another RO.