Radiation with no node involvement?
Dear all, from many posts I have seen that most of you receice radiation even when node negative. I had mastectomy, node negative and I am in chemo now bc of high ki67 and grade 2, and being premenopausal. I wonder whether I should ask for rads, because I read it can decrease recurrence risk. I am not sure I will get it, but what should be my arguments for getting it? I am somehow on the fence about this issue bc of possible heart problems later.
Comments
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What is you Onc suggesting? Did you have a lumpectomy? With a lumpectomy it is normal procedure. With mastectomy depends on how close the margins are I believe.
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Steff, if you are DCIS stage 0: Doctors make the decision to recommend radiation in DCIS based on the Van Nuys Protocol Index, here. There are factors that include age, grade, size, and margins.
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Steff if they get clear margins and your tumor isn't in certain locations (close to the chest wall) then you may not need radiation. Doctors don't want to over-treat. I was in a gray area and my rad onc gave me a pass because of all the aggressive treatment I've been doing. She didn't feel the need to further stress my body.
I would put some of these questions together when you meet with your rad onc. It seems they should be able to get clear margins with a 1cm tumor but that depends on where it is located.
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I am wondering if any of you have input for me as well. I had BMX for extensive DCIS, but my margins against the chest wall were 1mm - 2mm. My doc is saying radiation is overkill, but I am seeing a RO for a second opinion. Some studies act like 1mm margins are ok, others don't anyone know what is adequate with mastectomy? He couldn't take any more tissue or he would have had to take muscle. So, now, I'm at a lost. He said he would not have his wife do rads if it was her in my situation! Isn't anything ever easy when it comes to breast cancer!!
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My BS thought for sure I would need it especially with a tumor my size. My margin was .75mm from posterior region (I assume that's chest wall). But our cases aren't exactly alike. I also did 6 tx of THC continuing the year of Herceptin and Anastrozole. My Rad onc took that into consideration. I also think my tumor location (upper, outer left breast) might also have been a concern since it is near my heart. But I don't know that for sure.
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lago: Thanks, although our situations are different, it is good to know that your margins were narrow and no rads were recommended, although I'm sure the chemo sent those cancer cells for a loop! I guess I should be happy that they are saying I don't need rads, but I'm just afraid of what ifs?
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There are no guarantees with any treatment. I would ask for more information. I think you would feel more at ease if they shared the info/rational. Remember that radiation has SE too.
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lago: Very true, I plan to call my BS tomorrow for more details and then see what the RO suggests and go from there. Thanks for everything, just talking about my concerns with others helps. My husband just says let it go. He doesn't really have a clue so it's really no use to talk to him about any of this. He goes with whatever the docs say without question and thinks I am silly to even worry!
I know he means well, but.....it doesn't help much.
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mommyyrnx2, I have invasive cancer, mastectomy and the surgeon said 2mm clean margins. However, I've read that margins should be 5mm. With DCIS it is surely different, but best for you to get a second opinion.
Iago, my lump was at 13 hours, left breast, so there is a heart concern for me as well.I am so happy for you that you have finished chemo. I am still in the middle and will meet with a bc expert to discuss whether I sjould change to a tougher treatment with taxanes bc of high ki67. Being highly ER positive, it might not be beneficial. Hope to get some good advise and a final treatment plan.
Wish all of you the very best and good days! -
I was told at my biopsy the area was between 11:00 and 3:00! yeah that scared the hell out of me.
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Steff66- were you told that taxanes weren't that beneficial for ER+? I was told that, but I can't find it on the internet? Just curious.
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Interesting because I am hormone postive and got Taxotere/Carboplatin but I am HER2+ and grade 3
It might have to do more with the grade of your tumor than hormonal status.
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I think the taxanes are indicated for Her2 +
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Just to give you another opinion: I am triple negative, with high Ki67 and my tumor didn't respond until I started the Taxane. Also, I am 1 node positive and my rad onc recommended radiatioin due to the folllowing: new research out of Europe indicated benefit for 1-3 positive nodes (US has been doing rads with 4+ nodes), my age (33), and that I did chemo first, but still had a tumor 1X1X1 cm and node + at surgery. She said she would understand if I refused, but that was her recommendation.
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I also only had 1 postive node, but was told from the beginning that I should have RADS. This must be standard at my cancer center.
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Thanks again for the info.
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girls, do the rads, they break up cells left behind, I had no nodes involved and i did 35 rads/debi
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debi2009: Do you know if it's because yours wasn't just DCIS? I think that makes a difference doesn't it?
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why is my doctor recommending radiation for only 3 wks.? I had a lumpectomy , no cancer in margins or nodes. She said everything looks really good. Why only 3 wks.?
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I know the norm of treatment after lumpectomy is radiation, but why 3 weeks? The only thing I can think of is there are a lot of different types of radiation. Sorry I'm not much help, best to ask your doctor more questions. Good luck!
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Isn't that a good sign? That you would only need rads for 3 weeks? My onc said 4 weeks; but in my case he gave me the option of not doing rads at all due to my age (75)
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At 76 I was told I did not really have to get Rads..............Of course that was the opinion of everyone but my RO...........I had 2mm margins most of the way around the tumor, but in 1 spot it was 1.2mm, and l.5...............they all said that was good margin, no need to go back in............however, again my RO said............"I'm not happy with those narrow margins in that area (near the nipple...RT side breast).......................I asked her why she thought with my age, and mostly good margin she wanted Rads................................she looked me in the eye, and said................."insurance"....................I truely liked this woman, and asked her "off the record" what would you do"......................most will dance around an answer, and never give you one........................she said..............."I would have the Rads"...................so I did..............I felt she went out on a limb telling me that, since today with everyone suing everyone, she was taking a chance telling me that................I had no problems with Rads, and now I'm glad I did it..................its the AI, I'm fighting..............still have not started Femara.............uuugggg.
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vickilf, you may be doing the Canadian protocol--a slightly higher dosage per treatment for a shorter time period? Studies indicate it's just as effective as the standard US protocol, The dosages are hypofractionated. That's what I'm having, though mine's longer than 3 weeks' duration. Ask your RO.
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thanks everyone for the answers I will ask more questions this coming Thurs. Thanks!
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Vickif - that is the short version with stronger radiation - its like the canadian plan... no worries it gets everything needed... they do the longer rads when nodes are involved - mine was going to do the short 3 weeks but i had a micromatastes in one SN and no chemo, so RO opted to do the full 6 weeks for me...
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Got my oncotype test back yesterday, my score was 12, so I guess I will start radiation, no chemo on Sept. 6th for 16 treatments.
Diagnosis: 6/21/2011, IDC, encotype score 12, 1cm, stage 1, grade 2, 0/2 nodes, ER+/PR+ HER2- -
duckyb1 did u start your pill, Femara yet? If so I was wondering how your doing on the medication?
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lago, where in chicago were you treated? I live in Skokie.
A friend sent me an article from the NYT about a new study that shows that radiation is really good at preventing recurrences. I mentioned it to my Sloan dr and she didn't even consider it for me.
It's hard to understand everything. My margins were supposedly very wide but i did have invasion and those 100 cells in a a node. My onco here was supposed to ask a radiologist if i should get some treatment for escaped cells but he never got back to me on that.
I had a mastectomy, maybe the article was about lumpectomy? But radiation is standard for all lumpectomies anyway, i think.
BTW, I recently heard that an aspirin a day will cut cancer by 60%. I would have doubted this news more but I did get a consult at Columbia Pres in new york and she told me to take an aspirin a day. They think that breast cancer may be a result of inflammation, just as heart disease is. That's why aspirin and excercize cut the risk. Diabetes and overweight increase risk.
They are doing a huge study of metformin as a risk reducer. I am borderlind diabetic so I got a prescription. But I was told not to take it during chemo, the combination can hurt your kidneys.
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