radiation after bilateral mastectomy?

Nicoleb- I was in the same situation, 'grey area'.  Fought the idea of rads.  Ended up working with a RO who agreed to only radiate my axilla and supraclavical and not my chest wall - because it was my left side and I felt that based on my pathology that was the best treatment for me.  My MO agreed and supported my decision.  I also did not have ALND, so it was an unknown how many lymph nodes were actually involved, although I only had a 9% probability of additional lymph node involvement.

Do you know how much cancer was found in your lymph node, if extracapsular extension was present, and if you had lymph-vascular invasion?  Also, was your tumor located near your chest wall?  These are some of the factors I took into consideration before I made my decision.

Also, be sure to get the opinon of two or three ROs.  

Feel free to PM me. 

Regarding zero node status, two nodes were plucked from the sentinel node biopsy and two were found within the breast tissue during BMX - all four negative.  Apparently T3N0M0 is somewhat rare so for treatment, oncology doctors went on the assumption that there was node involvement ... but it was a Grade 1 cancer, which grows slowly so who knows?

I had a BMX & had bilateral IDC also. I will be starting RADs soon. Bilateral RADS. One side I have node involvement(RADs instead of ALND) & the other lyphatic vascular issues. Originally thought BMX meant no RADs. So many of us are finding out otherwise.

   I went for my markings on Friday. Everyone was nice but those machines make it seem so impersonable. As for quality of life, I hope I'm making the right decision. Everyday for 6weeks seems forever. The amount of redness & soreness seems to very from person to person. I Plan on just plowing thru it & hoping for the best.

Hi Nicole,

I was struggling with the same decision for a month.  I have 5 or 6 studies on this topic, none of which are conclusive for women who don't fit into the regular categories of those who definitely need rads (i.e. large tumor, more than 4 positive nodes, didn't clear margins at surgery).  I can photocopy and send to you if interested.

My take on these studies is that there are secondary  risks of recurrence beyond the classical categories listed above, which would be reduced by radiation even after mastectomy and ACT chemotherapy.  Some of those secondary risks seem to be a high  histological grade of the tumor (i.e. grade 3) and whether there is vascular invasion (this is in the path report).  I am choosing radiation because of being grade 3 with vasc invasion. 

Did the rad oncologist indicate if you have any other risk factors?  If I didn't, I would have skipped radiation so as not to put my body through that.  Yes, it is painless, but I fear heart or lung issues plus lymphadema.  Those are my thoughts on this issue.

Good luck with your decision, it's a hard one.

Laura

I was told that if I had more than three nodes I would need radiation.  You only have one!  Under these circumstances I would have been told that I do not need radiation. Are you BRCA+?  I am only asking this because a friend of mine who had one node and was BRCA+ regretted not having the radiation to her chest area after having a mastectomy.  She feels it may have prevented her from having the recurrence she ended up having five years later.  I hope you come to a decision soon and good luck! 

Nicole - I am 37 and had a BMX in December 2010.  I did 8 rounds of DD AC/T.  I, too, was told by my MO that I was in a gray area for rads since I had less than 4 positive nodes so he sent me for a consult with the RO.  The RO had a very different take on the issue.  He felt I was a prime candidate for rads considering I had node involvement and Grade 3 histology.  I completed 28 regular treatments (which consisted of three different fields - whole breast, axilla and clavicle) and 8 boosts to the MX scar line.  Rads has been pretty easy.  A little pinkness, a little tightness and the annoying fact of having to go to the office everyday but, other than that it has been uneventful.  I had my exchange surgery prior to rads at the urging of my PS and the implant has migrated higher on my chest.  I think I will require an additional surgery to correct this problem so I'm not sure what his thought process was, but I wouldn't recommend going that route.

Tammy

so... I had a lumpectomy in December, then chemo Jan-May and with only one micromet (very small) I have consistantly been told that if I have a BMX I did not need rads... Now that I am having a BMX next week, I am reading about a new study that says any node involvement would benefit from rads. Of course, not only am I now 9 weeks post chemo (past my window of optimal opportunity), but having surgery in just days. All of my 4 doctors (2 Bs, MO RO) all said no rads if I have MX... thoughts? Should I now be worried with the new study?? MO said chemo would have taken care of stray cancer even if it had passed thru the node... RO was pushing for rads, but thats his job... but at the end of my consult, he said maybe the MX would be better for me... and agreed if I get MX, I don't need rads, even for the nodal area... but has that thinking changed in the past month and a half??

Hi everyone,

It is interesting to read how many of us are in the "grey area"  I just completed 6 sessions of   chemo, although I still have about 6 more months of Herceptin.  I had a rt mastectomy, axillary node dissection in January and have tissue expander in.  Path report showed 2 out of 25 lymp nodes were positive.and I had 1 mm margin next to the skin.  Also one extra capsular extension in a lymph node.  So the radiation oncoloigst recommended 5 weeks radiation as an extra insurance policy.  However another radiation oncologist said I was in a grey area and that it was a  "complex difficult decision."   How do people make this decision and really figure out the   risk vs benefits.  I am concerned about lymphadema since he wants to radiate the axilla and I am already at risk due to surgical dissection.  Also concerned about heart damage because herceptin also can damage the heart valve  and my skin burns easily so not sure what radiation will do to the breast reconstruction.  The plastic surgeon plans to do the exchange after the radiation is done.  Any advice appreciated.  It is keeping me up thinking what to do , now 3:30AM

Dear Beeb and others in the "grey area" re decision to have radiation,

Your information was helpful.  Guess I will definitely get a 2nd and perhaps 3rd opinion.  The question is that when you see a radiation oncologist for the extra opinions,  is there a bias to recommending that  radiation done?? .  Kind of like when you see a surgeon they recommend surgery generally, or you see a naturopathic MD and they recommend vitamins.  How did people eliminate the potential  bias when getting a second or third opinion. It seems it should be a team decision since there are other factors involved  like impact on reconstruction, impact on skin/surgical site, impact on potential mobility if you get lymphadema.  Who did people go to for their second or third opinions  or perhaps I am just worrying too much about this?  Help!

I have been stewing all weekend over the issue of radiation after MX, as I am leaving tomorrow to get my MX... Just spoke with my MO and he said that in Eurpoe, the belief is to radiate if there were ANY positive nodes... And the US is different... He said that with one micromet, it does not warrant radiation... he said I am halfway between negative and positive... so not a full fledged positive node... and he would still feel this way if I had one or even two positive nodes... and three or more would get radiation.

Hi, I'm so glad you asked this question! I just came back from my RO consult and was told that I'm in the grey area also. I had BMX, one positive node, 4mm, poorly differentiated cells with lymph vascular invasion. I'm 32 years old and just finished chemo AC x4, Tx4. Ugh, I really don't want to do RADS but also don't want any regrets

Beep, I'm also getting treated at Sloan and your post is extremely helpful, thank you

I'm off to read the studies thanks everyone and OP.





Kim

I think there are ROs out there that may not have become believers in Rads following mastectomies. So if you keep looking you might find one. They may feel they have been doing things one way & their professional experiences don't see a need to change.

The positive node vs micromet question.....probably be harder to find a RO to agree to treating someone with micromets & MX with RADs. Currently micromets are grouped with node negative. Although this is not reassuring to those who have them.

I only went to one RO. I figured I'd just get similar %'s & would be told to weigh the pros & cons. Just like MOs. Yep, another delimma, another decision. In my situation I think it's justiified, Positive nodes on the left(3mm), vascular/lymphatic on the right.

How is reconstruction going nicole?  I find your topic very helpful.  I am in the same boat - did ACx4 & Tx4, completed BMX, had 2/7 lymph node involvement.  However, I am triplet negative.  Doc never said a word that I may need radiation after chemo & BMX if I had 3 or less lymph nodes involved.  When I went back post op, she suggested more chemo (b/c the tumor did not shrink in half) & rads.  The surgeon took out my port during surgery so if I opt. to do the chemo & the rad, I will be using my veins.  I plan to do additional chemo as a preventative measure, but am having a hard time swallowing rads.  I, too, started reconstruction with TE & was told I would never be happy with the end result if I do rads.  I have all the all clear right now & am cancer free.  Who knew decisions would be so tough.  Of my 4 docs, they all have different opinions.  Afraid to go for a 2nd opinion on rads as it may add even more confusion.