Is radiation necessary after chemo and bi-lateral Mastectomy?

andigall ~  I don't think it's as clear cut as if you have a mast and "x" # of positive nodes you do/do not need radiation.  A lot has to do with where your lesion(s) were located -- i.e. how close to the chest wall -- as well as other factors about your individual pathology.  But the rad onc you saw sounds like she's on the cutting edge of what's happening, which is what I learned when I was in a similar situation to yours and ended up doing rads.  The newest research, mostly from Europe, clearly does show increased survival for those who have rads after a mastectomy.  (I will try to find some of that research and post links.)

The other thing I would take into consideration is that you have ILC, which, as you may know, does tend to be a bit "trickier" than IDC, or so our doctors often tell us.

I ended up talking to 3 different rad oncs before I got comfortable with the realization that I was possibly taking a gamble (based on my pathology, which included a close, unspecified margin and a node with extracapsular extension ) if I didn't do rads.  You may want to talk to another rad onc for a 2nd opinion, especially to find out if there is anything specific in your pathology that indicates RT would be a wise choice.    Deanna

Here are some studies & articles that might be helpful ~

http://www.rsny.org/200_PDFs/GSL-RADIATION-AFTER-MASTECTOMY.pdf

http://www.cancer.gov/clinicaltrials/results/postsurgical-radiation0106

http://ukpmc.ac.uk/articlerender.cgi?accid=PMC2647547&tool=pmcentrez

I too fell  into the "gray" area for rads but the rads onc that I meet with took all if my specifics into account and we made the decision based on that. My tumor showed to have Extrnodule Exstention  ( cancer cells outside the tumor wall) as well and that was the weighing factor in my case. I figured if I could do chemo I could handle rads. 

My oncs convinced me right off the bat. Nothing was showing up in my nodes but my tumor was huge 5,5cm. And it didn't show up in mammography, even after I felt it.I had DCIS in 2002 so I as being watched, too,

They described this type of cancer as sneaky and creepy, crawly. It was enough to scare the wits out of me so I went through the rads after a double mast, AC/Taxol.

Got my tissue exchange Monday. It's been a long year but I am almost done. Hang in there, you'll be done, too ;o)

YoYo ~ Glad those articles were helpful, and congratulations on being finished with chemo!  YaY!!!  Hopefully, the worst is behind you now; at least, chemo was the worst part of this journey for me.  Rads, by comparison, was a piece of cake. 

It's interesting that your tumor was Grade 1 (least aggressive), and yet it was not only quite large, but you had those positive nodes.  I know ILC can hide and elude detection for years (I also had ILC), but your situation is an interesting example in how unique each of our bcs can be.     Deanna

My radonc gave me a 'probably not' recommendation for radiation.  Here's the thing.  You have to look at your specific situation and the context of the 2 studies that showed benefit for fewer than 3 nodes.

 In my case - 2 of 25 nodes, no lymph/angio involvement, grade 1, pre-menopausal, er/pr +, hr2 -.

 The Danish study - showed some survivor benefit for pre-meno women with 3 or fewer nodes. However, the average number of nodes removed was 7!  So some women were maybe 2/2 positive, maybe 3 of 7 positive.  So - one might surmise that there was disease in other nodes that was never detected hence the survivor benefit.  The other study was Canadian - it was smaller, average nodes removed was 11.   

So in my case - the possible benefit is not so clear.  I had clear margins, good testing of nodes (of course it doesn't include the nodes up by my neck, sternum), but there was no visible reason to be suspicious.  After chemo & with Tamoxifan - the benefit to radiation might not be worth the short/long term risks.

Apparently, I am a little unusual having grade 1, pre-menopausal and some of the other 'good' indicators, but none the less, I want to point out that in some particular situations a rad onc might NOT recommend rads. 

When my tumour was biopsied, I had an enlarged node that was biopsied as well. Both came back positive, so I knew I needed chemo. We did chemo first because they were hoping to shrink & do lumpectomy. Then we discovered another tumour in same breast, so will have mx now. My point is, even though I will have chemo and mx, my surgeon and rad onc both agree without a doubt, I need radiation. The surgeon said the concern is mostly the chest wall, because after mx, if a recurrence happens, this is the most likely place it will occur. 

I was premenopausal, grade 1, but even if I had chosen mastectomy over lumpectomy,  I would've ended up with radiation due to the location of my tumor. Tucked in between the fat layer under my skin and chest muscle way up on the left side, there was no way to get good margins no matter what type of surgery was done.

Hi Andigail,

Have you gotten a second opinion from another radiation oncologist?  I would suggest doing that. My radiation oncologist told me that there's a point at which research has shown positive results for radiation after masectomy and chemo  - which is dependent on tumor size (5 cm or larger) 4 or more positive nodes, and something about the tumor margins (i think when the margins aren't clean)...with the nodes and the margins more critical than the tumor size. I'm a little surprised that they are recommending radiation for you given your diagnosis, but of course - the doctors are experts in their fields...hmmmm - it's good your checking your options!

Hi Ladies, first i would like to wish you all a very healthy and a beautiful life. You are all brave people and so is my wife, who was diagnosed with breast cancer in June, 2010. I hope you will not mind my coming on to your forum but I need guidance in my wife's case. I hope some one will be of help.

The details are:

The lump size detected during mammograph was 4.0 x.4.1 x.4.6  cm at 4 o- clock position in the right breast.

We were asked to do further tests including biopsy ( true cut was suggested but the hardness of the lump did not allow that so only FNA was done), CT Scan and Bone Scan. FNA was inconclusive and both CT Scan and Bone scans were clear.

The surgeon suggested that we need to  do a frozen section i.e do a biopsy at the time of surgery, if the tumor is found to be malignant, they will do a mastectomy otherwise they will do lumpectomy.

After due deliberations and opinions we went ahead for the surgery and the doctor called me and my son and told us that the tumor is malignant and he has to do a mastectomy. We were a little unsure but did the doctors bidding and the mastectomy was performed. well and good.

Chemotherapy was to be started after the wound healed and that took about 3 and 1/2 weeks to heal. The pathology reports when they came in said that it was a IDC cancer tumor but all lymph nodes were unaffected, no invasion into the skeleton or the lungs or anywhere else, as we had seen in the CT Scan and the bone scans also, the tumor was removed with clear margins with any tumor affect.

The oncologist and the surgeon my wife was being treated by had to leave the hospital for some reason and we moved to another hospital, 6 chemotherapy sessions have been completed but now the Doctor is suggesting Radiation.

We are worried and concerned. Keeping in view that there was no invasion, nothing in the lymp nodes, is radiation required. They diagnose the tumor as Grade 3, just because of the size of the tumor and for no other reason.

What should we do? Go for radiation for 6 weeks or not? I will appreciate as much input we can have on this matter.

Thanks and best wishes.

I only had a lymphectomy, but I asked why I needed radiation after chemo and my oncologist said that the chemo gets to my body through the blood. Whereever there is surgery, the blood flow is disrupted, so the radiation is needed to target those areas. This may be why they are recommending radiation to you.