When would both Chemo AND Rads be indicated?

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jenlee
jenlee Member Posts: 504
edited June 2014 in Radiation Therapy - Before, During, and After

I'm currently halfway through 8 cycles of neoadjuvant TAC.  After 4 cycles, tumor has decreased by approx. 75%, so I'm hopeful about what 4 more cycles will do.  Plan is to have bilateral mastectomy afterwards.

Just curious, under what circumstances is Radiation recommended after chemo & mastectomy?  I have gotten such a bunch of mixed recommendations during this whole ordeal, as I'm sure many of you have.  Several surgeons recommended lumpectomy & several mastectomy.  I actually changed MO"s because the one I had chosen decided that I didn't need chemo and I was already sold on the benefits of chemo.  So I feel like I "chose" chemo and I am "choosing" mastectomy.  And will "choose" or even demand radiation if there is evidence that it would be beneficial.  They have found no evidence of node involvement, but my KI-67 was 75%, which continues to scare me.  Any thoughts on this?

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  • dlb823
    dlb823 Member Posts: 9,430
    edited February 2012

    jenlee, I had an mx, chemo and rads.  My indications for rads included a very close but unspecfied margin (because a bit of trimmed tissue held a surprise 4th lesion too small to have been seen on MRI), but any close margin would be a concern.  I also had a positive node that had extracapsular extension, which means the bc cells were trying to grow out of it.  Matted nodes present a similar concern. 

    One thing I did was talk to several rad oncs, to be sure I wasn't being over treated, and they all -- including the head of RT @ UCLA -- felt strongly that I would benefit from rads.  Also, remember, that unlike chemo, which treats you systemically, rads basically sterilizes the breast tissue to prevent a local recurrence if, for example, there were bc cells left in a close margin. 

    It sounds like you've had a good handle on your tx decisions so far, and I'm sure you'll make the right call re. rads, too.   (((Hugs))), and congrats on being halfway through chemo!    Deanna 

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  • jenlee
    jenlee Member Posts: 504
    edited February 2012

    Deanna, thank you for your quick reply.  Are the Rads directed at just the specific areas of concern (area of uneven margin & nodes) or the entire area & nodes?  I am a huge worrier...  Seems like most of the ladies here had many more nodes removed, not that I'm complaining about just having one removed in the sentinal node biopsy, just hope it was accurate.  Thank you, Jenifer

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  • hrf
    hrf Member Posts: 3,225
    edited February 2012

    Do you have RO? That's the doc with the answers

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  • Sandyland
    Sandyland Member Posts: 262
    edited February 2012

    Jenlee ~ I too had a mastectomy, chemo (I'm having my 6th and final TAC on Tuesday), and I'm starting rads a month later.  My Onc and the RO I consulted with initially thought I could go without rads, but my margins were clear, but not clean.  In other words, I had 5mm between my tumor and my skin and only 1/2 mm between my tumor and my chest wall.  My whole team agrees that I absolutely must undergo rads.  This was a gigantic disappointment to me because it means that I will no longer be a candidate for a simply implant.  Now I have to do the complex (and scary) tram flap reconstruction.  I'm very bummed, but I believe the rads will be well worth it, if we can kill any remaining "nests of cancer cells" as my Onc explained it.

    I believe that the entire area where the tumor was will need to be radiated, not just the boarders.  Best of luck!

    SAN

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  • jenlee
    jenlee Member Posts: 504
    edited February 2012

    hrf, no I don't have an RO yet.  I could be wrong, but guess I won't be seeing one until closer to surgery...?

    sandyland, Thank you for sharing the inof about your personal experience.  I'm so sorry that your margins weren't clean and that you'll require the more complex surgery. best wishes to you with the rest of your treatement.

    Jenifer 

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  • kyliet
    kyliet Member Posts: 687
    edited February 2012

    Hi, I am in Australia.  I am very confused and have been looking for a thread mentioning ECE (extracap. extension). I have done 1st FEC D chemo, then booked for RADs and hormones. It is not the treatment I am concerned about but not understanding whats going on. I have grade 1 which is slow growing, but i also had 3/26 positive nodes with ECE and cancer in lymphatic fluid. My surgeon said this wasn't great but he couldn't comment as he was 'only a surgeon', my GP said it wasn't good, sent me for a CT scan (all clear, YAY) but said he wasn't a cancer specialist so talk to onco. The onco just seemed to focus on treatment and said grade 1 with ECE etc was very unusual but no more info.  Has anyone else had this diagnosis? thanks, Kylie x

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  • itsjustme10
    itsjustme10 Member Posts: 796
    edited February 2012

    Sandyland...I had a BMX, chemo and rads, and I'm having implants.  My plastic surgeon said he won't do it in less than 6 months from the end of radiation (joy oh joy, I get to keep the TE's), but he said there will be no problem then.  It's just that the skin has to recover before they can do it.

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  • Terry71
    Terry71 Member Posts: 293
    edited February 2012

    HI Ladies- I finished my chemo FEC-D on Nov 17th 2011, had my mast on Dec 14th 2011 No biggie, started Rads on Jan 12th and finished feb 15th 2012...... I did not have reconstruction but will be..... Sandyland- Ask your PS about just having TE'S put in and filled, then removal to implants... I know several people that had this done TRAM flap is NOT the only option as I was told the same thing and said umm NO TY until I heard about the TE'S.... Not looking forward to any more surgery as I think Ive had enough LOL........ But looking forward to my new FOOBIES 

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  • sweetbean
    sweetbean Member Posts: 1,931
    edited February 2012

    JenLee,

    I had all of it, too.  My tumor was large and very close to the chest wall, plus I had nodal involvement and lymphatic invasion.  I had implants put in about 3 weeks ago, 7 months after completing rads.  The radiated side is a bit different, but it isn't too bad.  I am massaging like a crazy person to get that side to soften up and hopefully drop a bit. 

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  • TectonicShift
    TectonicShift Member Posts: 752
    edited March 2013

    Hi, Katopet. I am grade 1 with 5 nodes that had ECE and blood vessel involvement. It's the thing that worries me most of all. My onc didn't say anything about it. Neither did the second onc I consulted. They both said I have a better than 50% chance of being cured. When I hung my head and said, "I'm screwed," they both said something to the effect of, "No, not at all." So.... ECE is not a death sentence.

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  • lago
    lago Member Posts: 17,186
    edited March 2012

    There are a lot of different factors to consider when it comes to rads. My PS said there are so many things to consider now he doesn't keep up anymore. Typically if you have nodal involvement, tumor is close to chest wall or skin, or tumor is 5cm or greater rads can be expected with MX/BMX… but not always.

    My tumor was large (invasive part 5.5cm total tumor 6-6.5cm) but my Rad onc said I was in a gray area. To my surprise I got a pass on rads. My tumor was on the left (upper/outer quadrant). I'm sure the risk to my heart was also a consideration.

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  • Be_Positive
    Be_Positive Member Posts: 31
    edited March 2012

    I've also been told by my doctor that if you are triple negative (which I am) to expect radiation no matter what as it greatly reduces the recurrence rate.

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