Pathological Complete Response + Radiation???

Be_Positive · May 2012

Hi all TN ladies,

Wondering how many of you have had a pathological complete response? Were you still recommended to do radiation? My surgeon is of the opinion that if my path report shows a pathological complete response that there is no point in doing radiation. My radiologist admitted to me that he wants to "overtreat" me by radiating the chest wall, lymph nodes and my neck! I have read that TN who have a pathological complete response have very low levels of recurrence and very high rates of survival.

Any thoughts TN sisters?????

fightinhrd123 · May 2012

Did you have nodes pos b4 chemo? I had complete response, but still did rads, but i had 2 nodes pos b4 chemo

Be_Positive · May 2012

I had one "palpable" node, but they didn't do a fine needle aspiration to check for cancer. Surgeon said that is irrelevent and that it only matters what shows on path report.

yellowdoglady · May 2012

It is your choice of course. I was adamant to have what my oncologist would give his wife, sister or daughter or mother. So I threw the book at it. Six rounds (18 weeks) of chemo (cytoxin and taxotere), then 35 rounds of radiation (five days a week). I was less than 2cm, Stage IIb, Grade 3, triple negative, and 4/14 nodes taken were bad. Yes, the response to chemo was complete, but the radiation was to sanitize the local area after the chemo handled cleaning up the bloodstream.

If you had a palpable node that was not investigated, why? Because the surgeon did not excise it, it is not relevant? The path report will only report on what was sent in on a slide. If you had a clear sentinel node, then the others are irrelevant, because any bad news from the tumor must pass through the sentinel node before heading on to other lymph nodes outside the breast. Check your path report to see if you have a clear reading on the sentinel node. [That isn't any node in particular; it is the nearest to the tumor as determined by injecting a radioactive isotope and doing a geiger study. It is the canary in the coal mine, hence the "sentinel."]

Be_Positive · May 2012

yellowdoglady: how was your response to chemo complete if you had nodes that were bad? Pathological complete response means that there is no cancer left when they do the surgery.

Not every one is a candidate for a sentinal node biopsy and I am one of those people. My surgeon is going to remove some lymph nodes to check for cancer. A clean sentital node does not guarantee that the other nodes are not diseased, it just greatly reduces the likelihood of them having cancer.

I have no idea why my palpable node wasn't investigated before my chemo. I suspect it was because they wanted chemo started as fast as possible. Unfortunately I did not know enough at the time to request a biopsy on it.

Luah · May 2012

There is not always a clear winner sentinel node... and no guarantees that BC hasn't jumped to another node. My BS took four, because a couple lit up equally, and she took a bit more to be sure. What's more, experience is extremely important to yield meaningful results, and not all surgeons are up on SNB procedures. In experienced hands, I recall the success rate (meaning the BS gets the true sentinel and it yields accurate pathological information) was about 95%. But in some cases an ALND may be a better option (which I ended up having anyway in a 2nd surgery due to micromets in a sentinel.)

Be_Positive · May 2012

bump

bak94 · May 2012

Hi Be Positive,

I had triple neg with positive internal mammary nodes, which was confirmed by biopsy. I did chemo and all im nodes looked like they responded as well as the breast tumor. I then had bmx with 2 axillary nodes taken, all clear. They couldn't remove my internal mammary nodes with surgery, but my mo said most likely cancer is gone, nothing left to biopsy. Nothing showed up on any type of scan, pet/ct chest mri, breast mri and ct with and w/o contrast. I know, my doc is a bit scan crazy, I had them all! Anyways, everything that was taken with surgery was clear, but because they couldn't take everything (im nodes) my mo wanted me to do radiation. My ro said I could go either way, but would recommend radiation. I thought about getting another opinion, but I knew I would wind up doing the rads no matter what. I just wanted to do everything possible, to clean up anything that the surgery or chemo might have missed. I know my cancer is more advanced than yours, so your decison is based on different criteria. Are you worried about side effects of radiation? What does your mo say? I would listen more to my mo and ro with regards to radiation. Maybe a second opinion would help you decide. I know that if I was in your situation I would probably do radiation, but that is just me! I wish you luck in deciding! Congrats on the pcr!!!

dlb823 · May 2012

Be Positive... I posted the following on your earlier thread about this topic, but in case you're no longer following that thread, I think it's important enough to re-post here, with an apology for the duplication if you've already seen it... When I joined BCO in 2008, one of the women I immediately gravitated to was a very wittty, tell-it-like-it-is professor at the University of Texas who went by the screen name HeatherBlocklear. She was also TN. Although I'm not TN, something she posted about rads for TNs still rings in my subconscious as one of the most heartfelt posts I've ever read. Since she's no longer here to chime in, I found what she'd written in response to a very similar question, and am reposting it here for you, because I think this is exactly what Annie would tell you if she could:"Hi all,Sorry to have taken a couple of days to respond; things are hectic on campus at the end of the semester.I waited three months between the end of chemo and the start of radiation. Let me rectify that. The effing incompetent breast surgeon, who for reasons that are beyond me is the P.I. on an onoclogy trial, waited three months. I hear it's not unusual to wait up to two months, but three months is way beyond the norm. This said, my path results were so excellent the medical team apparently thought I was out of the woods, and the delay unimportant. Let this serve as a warning to everyone who is hesitating -- one is apparently NEVER out of the woods. Have the blasted rads.Axillary failure means the cancer came back in the underarm, probably because there were microscopic cancer cells remaining even after my "excellent" response to chemo. If not radiated, they start to grow again and form tumors that cast off cells that spread to bones and other organs via the bloodstream. Again, have the blasted rads. Do everything you can to stay SAFE.Love,Annie" Of course, Annie's heartfelt advice may not apply to every situation, nor do I know what advances there might have been in TN-specific tx protocols since 2008, when the above was written. But if you have a medical team that you trust, and if they are strongly recommending rads, this may not be the thing on which to second guess them. JMHO... Deanna PS ~ Just wanted to add... I did have rads, very reluctantly (left side, after a mx) because multiple rad oncs told me I should. And it was no big deal, although I did use some complementary things like healing touch massage.

bobsgirl · June 2012

I had pCR and I did 33 radiation treatments. It wasn't optional for me since my lump had been on my chest wall (but didn't invade it). Too close to the chest wall==radiation for me. I had a lumpectomy, but my rad onc told me that even if I had a MX, I would have radiation.

Luckily for me, radiation was a piece of cake compared to chemo. It was more of an annoyance than anything. I'm a fair-skinned redhead, so I thought I'd burn horribly. I didn't.

HTH and good luck!

della92 · June 2012

Hi,

I did not post while I was going through treatment, however, I did read the threads regularly. I was officially diagnosed with TN Stage II/borderline Stage III--4 cm tumor in my left breast on 8/2/11. I did 5 rounds of taxotere & cytotaxin--I was supposet to do 6 but I stopped and decided that if I needed it, I would do it after the surgery. I had a lumpectomy and a Sentinel Node biopsy. I had a complete pathological response yet after talking with the RO I still did 30 rounds of radiation. Radiation was a walk in the park compared to chemo. I am fair skinned, yet I did not peel, only turned bright--I was told that the radiation would drop recurrence rate from 40% down to less than 10%--even accounting for the CPR.

Hope it helps.

netty46 · January 2013

Im with you Radiation is a must.

yellowdoglady · January 2013

Be Positive,

Sorry, I don't get out here much anymore. But I'll tell you why.

Unlike many, I had my surgery first, then did chemo. No one expected any spread at all until pathology during surgery showed it. So a full response to chemo after surgery meant that there was no sign of cancer after that. There was not, and still is not over four years later. The sentinel node biopsy and axillary dissection were done during the surgery, which told us that the sentinel node was involved and four axillary lymph nodes as well. They were removed, as well as ten clean axillary lymph nodes just to be sure it was contained. Then I did an 18 week course of chemo with eight hours of taxotare and cytoxin every three weeks to prevent the growth of anything that might have escaped. Followed by 7 weeks of daily radiation therapy to sanitize the incision areas. That seems to have done the deed. In short, four years and a few months later, I appear fine. Six months ago, a PET/CT showed nothing at all. So they are still calling it a totally complete clinical response. I like that term, and will continue to use it unless and until I hear differently.

I know there is a lot of debate about order of treatment, and content of treatment, and length of treatment and such. And each and every one of us is different, and the beast that has tormented us all is of the same family, but not always exactly the same. How could I have a complete response to chemo after surgery? Because I had no chemo before surgery, any response would have to be after. And it was.

Good luck to you, my friend, and the rest of you who are still navigating those choppy waters.

Mumtobe · January 2013

Is a CPR a good sign of survival? Any stats out there?

Luah · January 2013

yes, google it and you will find the studies. For sure, studies have shown that a complete pathological response on neoadjuvent therapy yields better outcomes. But any response is positive.

Shari0707 · January 2013

Does this relate to non-tnbc. I mean what if there is no cancer in the nodes when there was before in horomone positve bc... Should they get rads there or is it overkill?

QueenKong · January 2013

I've consulted with oncologists at three different major institutions. I've had a CPR following neoadjuvant chemo and all say I need to get the radiation. I'm getting the radiation. I'm trying to figure out where and when but I want to start ASAP.

Pathological Complete Response + Radiation???

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