Purpose of whole breast radiation?

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DebRox
DebRox Member Posts: 437
edited June 2014 in Radiation Therapy - Before, During, and After

This may be a dumb question, but what is the purpose of whole breast rads?



I recently underwent a lumpectomy followed by partial breast rads - IORT. Intraoperative radiation therapy directed to the tumor bed at time of surgery. I have very wide margin 0.8-1.2 cm. This was all the radiation I required had my tumor remained under 2 cm. Unfortunately final path revealed the tumor of 2.4 cm pushing me out of protocol and requiring me to have while breast rads.



Needless to say I am upset I am being pushed into whole breast rads. The tumor was on my left side, so of course I worry about lungs and heart issues. In addition, I suffer from severe cording and worry about being predisposed to LE. My cording is not resolving and I fear rads will compound the problem.



I have finished chemo and won't chemo destroy and cells that may have gotten out? I was node negative.



In addition, I will be taking tamoxifen, isn't that supposed to protect the body from bc?



Why are whole breast rads necessary?

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  • Omaz
    Omaz Member Posts: 5,497
    edited August 2011
    DebRox - Did you get a second opinion?  To me your case seems unique in that you already had radiation to the tumor area.  I don't know how that works then with whole breast rads.  The idea that I heard about chemo and rads is that suppositely surgery affects the circulation in the breast and there is the possibility that chemo isn't delivered to the area as effectively.  The rads is to get rid of any remaining cells.  I am sorry to hear that your cording isn't getting better - I hope it starts to resolve soon!
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  • GmaFoley
    GmaFoley Member Posts: 7,091
    edited August 2011

    DebRox- I agree with Omaz.. I would ask for a second opinion.. Whole breast rads is going after any stray cells but if you had rads to the tumor area, I would think that would be enough... I didn't have chemo and I had a micromatastes in one sentinal node that was removed, so I had whole breast rads and lymphnodes...If you haven't checked yet, the lymphedema forums could help you with ideas for cording... I am so sorry you are going through this but if there is something you don't understand, don't agree to it until you do...

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  • DebRox
    DebRox Member Posts: 437
    edited August 2011

    Thanks for the responses so far.



    I plan on going for a second opinion, but unfortunately IORT is relatively new technology. It has only 10 years of clinical trial data, so I am in uncharted territory. I plan on going to UCLA for a second opinion, but I'm not sure if they have any experience with IORT. There arent too many facitilites using the technology.



    Of interest is USC has a current clinical trial underway with the Identical IORT technology that was administered to me and I meet their criteria. They are looking for patients with tumours less than 3cm.



    Ok so let's say chemo isn't delivered to the area effectively. What about tamoxifen? I will have to take that. Doesn't that protect the affected breast from future cancer? The tumour was excised with wide margins, clearly gone, saw US today.

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  • Omaz
    Omaz Member Posts: 5,497
    edited August 2011
    DebRox - good question about the tamoxifen.  I don't know the answer.
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  • bevin
    bevin Member Posts: 1,902
    edited August 2011

    Hi Debrox, I was offered this type of radiation as well and after consults, decided IORT wasn't for me. I had a primary tumor 2.1 cm with good margins, and also a second small site of DCIS. If I had IORT it could have missed any other little spots they could not see developing and later had a reoccurrence. The whole breast rads covers you for any spots they cant see via MRI etc as its yet too small, whereas the IORT would miss these growing spots because it is so targeted.  For me, I determined whole breast was a safer choice.

    On tamoxifen, I dont know the answer but assume you'll need to take it since hormone positive and its a huge part of our treatment success.

    Good luck in your decisions. I wish you the best.

    Bevin

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  • ICanDoThis
    ICanDoThis Member Posts: 1,473
    edited August 2011

    Deb - as I look back, one of the things that gives me the most comfort about non-recurrence is the lovely information in my path report about having margins almost 1 cm wide. When I first read it, I was like - cut out a lot of healthy boob there, dude, but now I am so glad to know that I had a tumor, a little cluster of DCIS, in a sea of normal, healthy tissue. I also had partial breast irradiation to sterilize that patch, but I know that I am lucky.

    I think we forget that sometimes it's okay to trust our luck!

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited August 2011

    I was offered IORT and declined after doing my own research. Instead chose whole breast radiation for left side.  When I had my lumpectomy, I was told that for women under 70 radiation was the standard of care with lumpectomy and that survival was comparable to mastectomy.  Whole breast radiation sterilizes the whole breast...which sounded good to me despite the risks of heart and lung issues.  I developed cording as well....along with a frozen shoulder, bursitis, tendenosis, small rotator cuff tear and entrapment.  Had shoulder surgery in April and all is well now.   No side effects from Tamoxifen or from Lupron injections either.  Also doing Zometa for 3 years at 6 month intervals. 

    Good luck.

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  • Binney4
    Binney4 Member Posts: 8,609
    edited August 2011

    Deb, here's cording information, in case you haven't already gotten help with it:

    http://www.stepup-speakout.org/Cording_and_Axillary_Web_Syndrome.htm

    I'm really sorry you're having to make such huge decisions. Hoping you'll soon have peace about whatever decision you make. Be well,
    Binney

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