Memorial Sloan-Kettering study

Hi Tim,

It's encouraging to see MSK's study which demonstrates a concerted pace to cancer surgery with expander, chemotherapy, implant exchange and lastly radiation, with "acceptable" 5 year survival (their word). I see their study as an attempt to clarify the timing involved in all of the above, as well as the individual outcome in terms of disease and survival. Efficiency in work process I guess can apply in breast cancer treatments also, and working out the details by close tracking is a valuable study. I do wonder how the women did in terms of skin fibrosis and contracture, given the radiation was last with implants in. And of course, as would the researchers and patients, ideally an "optimal" outcome is preferable to "acceptable".

You ask if all radiation techniques are the same. I believe it's reasonable to say that competent radiation oncologists work within similar guidelines. Yet as some on this site will attest, variances in delivery of external beam radiation may occur (computerized simulation vs non, variation in actual delivery, interruption of course of therapy or other adjustments perhaps due to patient needs or skin reactions). All hospitals machinery undergoes quality assurance testing and adjustment, so one shouldn't have to worry too much about that aspect.

As to the axilla and clavicle regions, yes that is included in the radiation field to reduce recurrence. You might ask too if consideration in your wife's case is being given to the internal mammary lymph nodes, near the sternum. Doctors vary some on inclusion reasons for this lymph node area.

I did have radiation, and all went well. I'm seven years out now (had lymph node involvement) and had implants years after treatment which my skin tolerated o.k. No contracture, just occasional redness. They did include the axilla and clavicle area but not the internal mammary area to reduce the recurrence risk. I think rads can affect the shoulder union with the clavicle some, but just my opinion. Lymphedema is swelling of the arm, and surgery plus radiation together raises the risk of LE quite high, but each person is unique in their reaction.

I hope this helps some. I wish your wife well and long years. She is a fortunate woman to have a caring husband such as yourself, who even checks out information on care/treatment on his own. We have had other men similarly help their spouses, and I for one encourage the spouses engagement in such a manner.

My best to you both,

Tender 

Tim - I, as a fellow stage 3er, am liking that "acceptable outcome"   My treatment was almost identical to the study though a little faster by a week here and there - in the middle of the night I sometimes think about the 4 weeks after surgery that I had no chemo or the 3 weeks waiting for surgery to heal....this study makes me feel better.  (By the way my surgery and initial consults were all done at Memorial Sloan Kettering - we then chose to come closer to home for treatment).

It is a small study so that could be part of why the results are better than most of the stats we read but it is also based on newer treatments.  My husband told me to print the study out and read it every night before I go to bed - its nice to see odds like that for a change.

ps - I don't know if you have already looked into Zometa for your wife (after treatment) but it seems like a logical next step (at least for me).

I would like to know more about what drugs were employed in the chemotherapy regimen used during this study. I think the taxanes were still in clinical trials during this time; these are the drugs that have made such a difference esp. for node-positive women. If a taxane wasn't used, the stats could even be higher.

I was also diagnosed at 39 - I got 3 opinions with three different oncs.

1st opinon was at MSK - AC/T DD, radiation, tamox.  Said ooph was completely unwarranted and that Femara had not been proven to be any better than Tamox (At SABC in Dec. Femara has been since been proven to be slightly more effective than Tamox)

2nd opinion - AC/T DD, radiation and Tamox and then Femara.  When I asked about ooph he said it wasnt unreasonable and that Femara was probably a tad more effective than Tamox.

3rd opinion AC/T DD, radiation and Lupron (to shut down ovaries) and Femara.  I said I would rather just have ooph and onc said that she was concerned about long term side effects but wasnt completely against it. So I did it.

Femara has been proven to be slightly more effective than Tamoxifen.  I, personally, just dont trust or want Lupron injections. My feeling is that if I have my ovaries removed then there is no question that I have reduced the estrogen in my system. 

I had a hyst/ooph (gyn surgeon said might as well remove it all) in december and started tamox while still on radiation.  Onc will test hormone levels at the end of month and I will switch to Femara then. I will have Zometa (to prevent osteoporisis and hopefully mets as well).  I am very active and keep my body weight low to normal and have low blood pressure. 

The reason they hesitate to do it is....if we are cured by surgery and chemo then it is unnecc and we will presumably live a long time with no hormones which can cause other problems (heart, bone, etc). 

JacquelineG -

It is a gamble - if we are already cured by surgery, chemo, etc then the ooph/hyst is not neccesary and could actually age us faster meaning we could die younger.  If there are any remaining cancer cells then having the ooph may starve them and we could live longer. 

For me it was an easy decision but so was a bilateral mast.  I am kind of resolved to the fact that I may not live til 99 but I would really like to see 60!

I was treated at (and still go to) MSK for chemo, herceptin and thyroid cancer surgery and RAI and Endo follow up. So I'm visiting New York fairly often, or at least I was. I did my rads locally because it is a 3 hour drive to NY. My Onc knew my Rads Onc because he studied at MSK and that made it easier.  Pretty much they had exactly the same equipment.  I just wanted to say that I was er/pr neg, but followed exactly the same time frames between surgery, chemo, rads. Yes, they did rads to four areas due to pos nodes everywhere. I'm 5 years out and still NED.

MSK is one of the only universities currently recommending that implant exchange occur PRIOR to radiation. Their studies show that it is more effective over the long term course of treatment. I have spoken with them a few times and had my case reviewed. More than likely, I will be proceeding with their protocol. Currently I am on target for April, and will keep my fingers crossed. 

Hello Tim and Bev,

You sound like a wonderful couple...and very supportive of each other.  It's difficult times such as these that really helps define our relationships, don't you think?  My husband at first could not hear anything "bad" and wanted to only focus on the positive (I guess that isn't so bad)...but I really needed someone to hear how afraid I was.  He finally did understand and now he has moved past the angry part (he admitted how angry he was at life that I should get cancer...me of all people...he couldn't accept it) and is very supportive.  Initially he didn't like me "chatting" on this web site but now he sees how valuable it is to me...and ultimately to him.  Take care Tim and good luck to you both.