Skipping radiation if you are Her2+++ and over 70

Gundersk

I have just completed TCHP chemo followed by a lumpectomy. Total pathological response and no lymph node involvement. I am wondering if any of you Her2+ ladies have made a decision to skip radiation. Studies shared with me by SpecialK show that skipping rads in older women with smaller tumors had no impact on survival, but nothing is published yet for Her2+ women doing that. My tumor was stage 1, <1cm, grade 2. Any thoughts or experiences? My radonc gave me his blessing to skip, but he can't make a formal recommendation due to lack of data. Thanks!

Wanda1978

I skipped radiation. I just turned 60, completed TCHP chemo in January 2020 and lucked out with a PCR response. I discussed radiation with the radiation oncologist and decided not to do it. Between the COVID mess and the possible side effects, the risks outweighed the benefits or at least that's what I thought at the time. However, I do find myself second guessing my choice not to do it, but the RO thought I would do ok without it, so we'll see. I have/had triple positive and had a BMX

Gundersk

Thanks for the reply, Wanda1978. I am vacillating so much due to my concern about side effects. Excuse my ignorance, but is a BMX a bilateral mastectomy? I only got a lumpectomy, although you and I have a very similar diagnosis.

MinusTwo

I did not skip rads and I was 70. My MO felt that HER+ was a deal breaker if I didn't want to be back yet again at 80. On the other hand, my genes tend to long life and most don't die until mid-90. I wanted to give myself the best chance to make 96

Cowgirl13

I was 63 when I had radiation and it was a very, very easy for me. I had a shorter protocol which was about 19 rounds. You might want to consider that there is this shorter protocol. I had no problems with my skin. If I were 70 and going through this I would definitely have radiation as HER2 is very aggressive. Good luck on your decision.

MinusTwo

BTW - I had a very easy time too. I had 33 doses and drove myself to each one. Luckily never got burns. It takes longer to get there & get changed than for the zap. The only real side effect I had was fatigue. That is cumulative, but who knows how much of that was prior unrelieved fatigue from chemo.

Gundersk

Thank you Minus Two and Cowgirls. I have decided to do it now based on the same thoughts you all expressed. I don't want to be in a recurrence situation where I am thinking wouda, coulda, shoulda... I fully understand it still can come back, but have decided to bite the bullet and do it. This forum is the best! Really, thanks so much.

Cowgirl13

So glad you have made your decision and are comfortable with it.

SpecialK

gundersk - I am glad you are doing the rads too, I was treated a few years ago, but am now almost 64 and would do rads if needed. I have always been the personality type you describe, would have regrets if I didn't do all available treatment that I could. Ask your RO about the traditional course of rads and the shorter Canadian protocol, less days of treatment but the same number of grays administered - there may be age related pros and cons for both.

Wanda1978

Yes, glad that you have made the decision that is best for you. I did have a bilateral mastectomy and both my onc and rad onc concurred on no rads, and I agreed with their decision for my situation, but it's something I will always second guess.

Gundersk

Hi SpecialK, thanks for the Canadian protocol information. I am scheduled for 20 sessions, but I don't know if that is traditional or short. I am doing the planning with him now, so I will ask. Thanks so much!

SpecialK

gundersk - sounds like the short course (Canadian), maybe with a few boosts? It is commonly 3 weeks - 5 days a week, so 15 sessions, maybe with 5 boosts?

Gundersk

Hmm, maybe. This is 20 sessions over 4 weeks. The last 4 sessions are partial breast radiation specifically to the tumor site. I will ask.

SpecialK

I believe those last ones would be the boosts. Here is a Komen blurb:

Gundersk

Aha, got it, SpecialK Thanks!