Stage 1, grade 3 left, radiation or not?

July152020

I read that radiation on left chest might cause lung and heart issues later.

I wanted to do a lumpectomy so that I can recover faster but I am really worried about the side effect.

Another option is mastectomy and no radiation. I plan to meet a RO to talk more.

Looking for suggestions.

thanks

MinusTwo

Talk to your docs and meet with a radiation oncologist before you make a decision. There are ways to protect the heart and it depends on where your tumors are located.

moth

there are special machines and techniques to minimize risk. Speak to your RO about what is available. I was told most people are more at risk for heart problems due to inactivity, diet, cholesterol, high BP etc. They prescribe rads if they believe the benefits outweigh the risks.

You should also consider that a mastectomy doesn't guarantee you won't need rads. If they find lymph node involvement during surgery, you'd still be recommended rads.

Best wishes

Moderators

Welcome, July152020-

We're so sorry you find yourself here, but we hope you find this to be a supportive place. We know you're faced with a lot of difficult decisions, but we second what Moth and MinusTwo said about talking over your options with your RO. Please let us know what you decide, we're here to support you!

The Mods

AliceBastable

I had a left side lumpectomy. My radiation oncologist told me there's no chance of damage to heart or lungs with the way they map it out. Then I had an appointment with a cardiothoracic surgeon about six months after rads and we were discussing a possible future surgery (for an unrelated problem). I mentioned radiation because I wondered if it would make healing from an incision difficult. He told me it would also have caused heart damage. When I told him what the RO had said, he just shook his head and told me there's ALWAYS damage. Then I had my periodic chest, pelvis, abdomen CT for another unrelated issue, and there was a new smudge on my left lung, which the radiologist read as radiation scarring. At least that seems to have improved slightly on subsequent scans. It could be that my RO was an incompetent, lying dick, or it could be that they all pretend there's no damage. And maybe some are so skilled that they do avoid the heart and lungs. But I'd grill the hell out of your radiologist at the initial appointment. Since yours is a grade 3, I'd also ask a lot of questions of your MO about risk assessment for recurrence. Good luck.

Greeneggs

I faced the same question about left sided radiation and cardiac issues this past spring. Your tumor differs from mine, including its position relative to the heart, but maybe my experience will help your thought process.

I considered forgoing radiation because my tumor was small and strongly hormone receptor positive (Stage I, 99% ER and PR +, Grade 2). I thought hormonal management would be sufficient. However, the RO advised me to strongly consider some form of radiation therapy because of the possibility that I would not tolerate (or not choose to tolerate) the side effects of hormonal therapy. She was right. I am discontinuing AI and am now glad I had radiation.

More importantly, my RO helped personalize my radiation choices. After lengthy discussions, I ended up selecting intensity modulated (less dose to the heart) and partial radiation (rather than whole breast). The RO showed me the maps they generated, where my tumor was, where my heart was on the map and what the exact dose would be to both my left lung and my heart.

Not every radiation facility can do more specialized types of breast radiation. It depends both on the equipment capability and the professional staff. The RO facility that did mine was the second place I evaluated. The first one had more of a "one size fits all" approach of doing the 5-7 weeks of whole breast radiation protocol (not even an option to do the shorter hypofractionated protocols).

Important for your to keep asking questions until you are satisfied and have confidence in your RO and the RO team.

Best wishes to you.

edj3

Stage 1, grade 2 here--left side just like you. I knew there was a decent change I wouldn't take tamoxifen, so I absolutely chose to do radiation. And sure enough, while I did try the tamoxifen, ultimately I decided the side effects interfered too much with activities I like to do.

So for me, the lumpectomy and radiation were the way to go.

July152020

thanks everyone for your response. It does look like because I have at least one node involved, I'd need radiation no matter what. So I decided to go with lumpectomy. My surgery is in 2 days.

Ingerp

Really it'll be fine. The equipment is so good these days. I did the deep inspiration breath hold and it was really not a big deal at all. My RO looked me in the face and told me <twice>, "I will not irradiate your heart or lungs." I've had no issues.