Time frame for radiation after lumpectomy ctomy

Jos_3rd · June 2011

In February after a mammogram, followed by ultrasound, a radiologist discovered a 7-mm, pea-sized mass in my right breast at "10 o'clock". DCIS was suspected, then diagnosed. No family history of breast cancer. Pathology report indicated intermediate to high grad DCIS with cribiform, solid and comedo patterns. Tumor was ER+. After undergoing a lumpectomy in late March, I was given the facts and stats re: radiation and Tamoxifen in late April. In May I turned 61. I'll be monitored by my surgeon every six months. The oncologist said I should have the radiation done within 90 days of my surgery. I'm calm, but still dithering about having radiation and taking Tamoxifen. Can anyone shed some light on what is important about having radiation within '90 days' of surgery? Thanks! -Jos_3rd

Jelson · June 2011

I googled lumpectomy delayed radiation and found this discussion

http://ww5.komen.org/KomenNewsArticle.aspx?id=6442452012 on the consequences of delaying radiation.

The Van Nuys prognostic index (VNPI) is often used to determine whether there is a good possibility that post lumpectomy for DCIS radiation won't be necessary. Have you checked that out?

did you have wide margins? Was 7mm the final size of the mass post lumpectomy, or was that the estimate based on ultrasound?

You are "dithering" but what are the issues you are wrestling with that are preventing you from making a decision about moving forward with the treatments recommended to you? have you spoken with a radiology oncologist?

You are my age and I dither about alot of stuff, but not about breast cancer. By continuing to dither, you are making a decision not to have radiation or take tamoxifen. That is a legitimate choice, but you should actually make that choice mindfully and be sure you are comfortable with it. There is alot of information on this site in the resources section as well as the discussion boards.

Take care of yourself

Julie E

Jos_3rd · June 2011

Thanks for your input and support, Julie E. I will look at the article you have sited. The surgeon did excise a 7-mm mass and the surgery was a breeze. (Surgery was on a Friday and I was back at work on Monday.) So I suppose I'm dithering about radiation and tamoxifen because of their side effects and my fear of being overtreated. I have been reading as much as I can about both treatments since I joined this site in February. A few weeks before my diagnosis I started a new job. I have kept the diagnosis to myself and do not relish the idea of menopausal symptoms returning. Also, my oncologist mentioned that in Canada I would probably receive 3 weeks of radiation, whereas in the US 5-6 weeks is prescribed. The decision for one or the other is up to me. I'm just having a hard time deciding, I guess. Thanks again for your comments, Julie.

Jelson · June 2011

I think you need to talk to a radiologist.

Depending of course on the location where you will get your radiation, if you choose to do so, you can schedule it before or after work, or even during your lunch break. Once you have had your preparatory appts, the actual "zaps" only take a few minutes.

some women's tumors meet the criteria for mammosite, a 1 week (more intensive) option - - I have copied this from the Fox Chase website. there is probably info about it on BCO as well:

MammoSite™
Recent advances in brachytherapy allow doctors to apply this technology to provide radiation to the breast tumor, rather than irradiating the whole breast, which is generally performed. Brachytherapy with the MammoSite™ takes 5 days instead of up to 7 weeks that external radiation can require.

Similar to brachytherapy, seeds are placed near the tumor in a temporary balloon. The balloon stays in the breast for 7-10 days and is placed either at the time of lumpectomy or afterwards under ultrasound. The placement takes only 10-20 minutes. It is performed with a local anesthetic without the need for stitches. The radioactivity is placed into the balloon twice a day for 5 days, each treatment taking only 5 minutes. Apart from these times, the balloon is not radioactive. After the last treatment, the balloon is deflated and easily removed from the breast. Doctors continue to study this technique to determine if it is as effective as external beam therapy for treating breast cancer.

Julie E

Jos_3rd · June 2011

Yes, you're right, I do need to see a radiologist. I live in a major metropolitan area, so part of my indecisiveness about radiation is because the hospital where I chose to have the surgery is too far away to get to on a daily basis for the radiation. So thank you for prompting me to get on with this. I do have my prescription for Tamoxifen, but my understanding is that radiation needs to be completed before I begin to take it. Thanks for your concern and direction, Julie.

SJW1 · June 2011

Jos,

I had a lumpectomy in 2007 for DCIS and decided to omit radiation and tamoxifen after consulting with Dr. Michael Lagios, a world renowned DCIS expert and pathologist with a consulting service that anyone can use.

He used the Van Nuys Prognostic Index to calculate my risk of recurrence at only 4 percent without radiation. This is based on age, size and grade of your DCIS and size of your margins. With such a low risk, the 50 percent reduction that radiation brings weren't worth it to me.

If you are comfortable with omitting radiation, you too might be a good candidate. Since you can only do radiation once, you will want to make sure that the benefits are worth the risks to you.

Please feel free to PM me if you have any questions. You can also check my website if you prefer at: https://sites.google.com/site/dciswithoutrads/home

Best,

Sandie

Jos_3rd · June 2011

Thanks for your input, Sandie. I will check out your website. I see from your post your situation is Grade 1. Since my pathology report indicated intermediate to high grade DCIS, I'm assuming that means my cells were Grades 2 & 3. So that is most likely why I am being encouraged to have radiation and take Tamoxifen.

My initial concern when posting on this site was to see if anyone could tell me what is significant about having radiation within 90 days of one's surgery. My surgeon is supportive of whatever I choose to do, but cautioned me that if the DCIS shows up again, my breast is too small to do another lumpectomy. So a mastectomy would be the next step. Thanks again.

redsox · June 2011

There is no magic number for the elapsed time from surgery to radiation therapy for DCIS, but the goal is to kill any remaining cancer cells before they have time to multiply or become invasive -- so sooner is better.

You should at least consult a radiation oncologist but you do not have to go to the same hospital as you went to for surgery.

Jos_3rd · June 2011

Thanks, Redsox. Of course, 'sooner is better' makes a great deal of sense and I do know the goal. I did learn from the oncologist that everyone is prescribed Tamoxifen/20 mg daily. That was surprising. So I just wondered what was magic about the 90-days time frame for radiation.

I've just applied my numbers to Sandie's suggested VNPI. I'm in the 7-8 range, so that is probably why I'm being encouraged by my docs to do both radiation and Tamoxifen. I am the risk-adverse type, but still want to understand this treatment process from all angles before I make a decision. I do appreciate your response.

DeeLJ · June 2011

I can chime in here that I met with a rad-onc last week that told me I have 16 weeks from the date of my excisional biopsy to start radiation. Sooner is better, but she said there is time Obviously everyone is different, but that's what she told me.

Jos_3rd · June 2011

Good to have your input, DeeLJ. Thanks.

Time frame for radiation after lumpectomy ctomy

Comments

Categories