Radiation reccom.for 1 node and BMX?

Joanne58 -  I am in a similiar situation.  Cancer was on the left side and I am currenting doing DD AC+T for chemo.  I had a BMX, 2 sentinel nodes positive.  Everything else was clear.  I did not have ALND since I was clinically node-negative before surgery and had only a 9% probably of additional lymph node involvement.  My Surgical Onc, MedOnc., and my second opinon MedOnc all feel that I don't need to do radiation to my chest wall.  My MedOnc thinks I should consider radiation for the axilla only.  However, the Radiation Oncologist says that their 'standard of care' requires them to radiate both the chest wall and axilla.  So now I in the process of getting a second radiation opinion, and having the first Radiation Oncologist take my case to the tumor board because I am open to radiation of the axilla (although it increases the risk for lymphedema), but not open to to radiation of my chest.  Unfortunately I was not able to have the OncoType test because my insurance would not pay for it since I had a positive node.  So I am missing that one piece of info on chances of recurrance based on the results of that test.  I am also 100% ER/PR positive so I will be taking Tamoxifin to cut off the supply of food in case the cancer tries to come back.

Definitely het at least two opinions from different radiation oncologist.  If you are being treated at a Cancer Center then get the other opinion for a radiation specialty clinic, because my understanding is that sometimes the large cancer centers have the same 'standard of care' and you definitely want an opinion from a different respectable perspective, so do a little homework on a where to get a good second opinion from.

Bottom line for me will be, if they will not exclude the chest wall from the radiation, then I will not undergo radiation and put my heart at additional risk because I don't think the risk to my heart will be a benefit with the pathology of my cancer.  Hopefully they will let me radiate the axilla only, but if not, I am OK with no radiation, it was just going to be that little extra insurance, but even that little extra insurance is not a 100% guarantee.  I think my lifestyle changes, i.e., diet and exercise, may play a bigger role in preventing a recurrance.    

Please let us know why you decide.  Good luck and sending good thoughts your way.

Joanne58 - have you decided on Rads?

Got my second opinion.  And I was really impressed with the RO.  The other one was good too, but kept sticking with the standard of care.  This one talked about what my odds were with sticking with the cookbook , not sticking with the cookbook, and recreating my own recipe.  So I am going with him and radiating my superclavical and axilla lymph nodes only.

Basically since I had 2 positive, did not have ALND, and my pathology regarding the chest area was good, he said he thought it was OK not to radiate my chest wall.  However he really wanted me to radiate the superclavical and axilla.  He said the method he would use would be to radiate from above the collar bone and then aim towards the axilla.  He will probably nick my lung, won't be able to tell until I have a CT Scan, but that since I was otherwise healthy and it should not impact my way of life since I am not a high performing athlete.  It will impact me, but not in a debilitating way.  

He said the main reason to treat the lymph nodes in my case is because if I got a recurrance in the lymph nodes the odds are by the time they detected it I would be Stage IV, because I was clinically node negative until I had the surgery, no one felt or saw that the lymph nodes had cancer, and I had 9mm in one lymph node and 7mm in the other.  Even though chemo has really improved, there are not enough studies supporting skipping radiation in my instance, which I knew.  So he was a good salesman for Rads in my case and I will be starting rads mid-May.

Edited to correct the measurements in the lymph nodes.  Oops.