"You may or may not undergo Radiation Therapy"

I too was in a grey area. Usually tumors over 5cm (mine was 6.5cm in the posterior region right over my heart) get rads. I think in my case my heart, lungs and bones definitely would have been affected. Benefit not worth the risk for me. My RadOnc said I was getting such agressive treatment that she was giving me a pass.

But I didn't have any node involement.

I won't be having radiation as this is whats caused my BC.

I was dx with Hodgkin's disease in 1996 see below details....mantle radiation caused my BC and thus through lots of discussions etc rad doc said that I could have radiation again .. i've opted for no no no. My onc seems to think that even with rads the benefit isn't all that different even with 2 positive nodes out of 10.

I did have axillary clearance though and will be having a BMX after chemo

I've just completed Taxotere and starting CMF x 3 in Jan.

Good luck with what ever you choose

PixieNel, my diagnosis was very different from yours so I don't want to tell you about my personal experience, other than that I did have radiation.  

I do want to urge you as you make your decision to be sure you are factoring in what I think are the really important side effects from radiation.  You'll hear a lot of people say it was easy, or they were tired or burned but that got better, but those are all things that are temporary.  Radiation inevitably causes permanent, irreversible damage to the normal tissue in the field which is often not very visible.  Of course, sometimes it's very visible, but either way, it's there.  Wounds and infections aren't expected to heal as well.  There's a reason there is a local limit to how much radiation any specific part can receive:  after too much the tissue kind of falls apart.  

But as I said, I did choose radiation.  With my particular cancer, my risk of local recurrence was fairly high.  Radiation's biggest effect is in decreasing the risk of local recurrence.  It wasn't until the past 2 years or so that it was even shown to have any effect on survival.  That was difficult information to get because it's been standard of care for so long for a lot of breast cancer because of the improvement in local recurrence.  I don't want to pretend to know your personal risks of recurrence, but when you look at a number like 7.3%, it's important to know if that means relative or absolute risk reduction.  

Usually, when risk reduction is published, relative risk is the number made more prominent because it's larger and looks more impressive.  Say you have a recurrence risk of 10% (just making that up).  A treatment with a relative risk reduction of 20%, which sounds like a lot, would actually only mean a 20% reduction of 10%, not 100%.  Your absolute risk would go down fom 10% to an 8%.   

I know my radiation oncologist would have gone over my own numbers in that kind of detail.  Of course, it's all risk, nobody can say for sure what will happen to you in particular, but treatment decisions are basically playing the odds.  

PixieNel I would also look at if you decide no and did get a local recurrance, what would the treatment be?

PixieNel if you choose not to have radiation and have a local recurrence you might get both systemic and radiation but you'd have to ask your onc to be sure.

PixieNel - I also fell into the grey area and had a difficult time with the decision and got multiple opinions on it.  The biggest argument for radiation in my case was that I had 2 positive nodes (more invasive cancer found there than in my breast) and I refused the ALND.  However I did not want my chest wall radiated because it was on the left side and I did not want my heart to be radiated.  My doctors said if I chose no radiation at all they were OK with it, after all it was a grey area.  Ended up formulating a compromise.  Had my axilla and supraclavical radiated and no radiation to my chest wall.  We discussed potential options if I had a recurrance (knowing that things could change if it did happend).  My MO said if I got a local recurrance then I would still have the ability to radiate that area.  The approach I went with for radiation is considered going outside the 'standard of care'.

It is a touch decision, go with your gut feelings.  

Hi everyone

I find this topic interesting as I was faced with a similar decision, thought I had made it and now it is being suggested to me that I get a second opinion (from a friend who works in radiation oncology area as a nurse).

My story - I was referred by my MO to see the RO, appointment was November 9th. It was the end of the day on a Friday. The RO seemed very distracted, a medical student did the questioning and the exam and the RO did not seem very familiar with my pathology, when I mentioned different parts of it I had to show her in my pathology report where I read it. She seemed to shrug off my pathology or need for radiation, suggesting that it would be of minimal benefit for me with my tumor size and having had a mastectomy. I stopped asking questions after my concerns continued to be shrugged off.

Now I am being told that I should reconsider the decision not to have radiation and so I have been researching. I have a few questions/concerns that I am wondering if anyone can help me with.

When they look at tumor size when considering need for radiation do they combine IDC and DCIS or do they just look at the size of the IDC? If combined it would seem to be indicated by my pathology and node involvement.

I had two nodes out of 27 positive for macrometastases, the largest areas was .5 cm, it seems that others had radiation recommended for much less than this amount.

It seems to me that if my IDC was just under 2 cm but I already had macrometastases to two lymph nodes and I was HER2 positive that this would indicate the cancer was fairly aggressive, therefore should be treated aggressively.

Has anyone had a port on the mastectomy side and still had radiation or is this a contraindication, it wasn't discussed with me.my port is for my Herceptin treatments and the surgeon who inserted it insisted that it be on the right side which is my surgical side.

Input is appreciated. Thank you

Thanks, Lago, I appreciate your answer.

I will be getting a second opinion, some on line research I found this evening from University of Pennsylvania, May 2010 -



'PMRT in women with 1‐3 positive nodes remains controversial. However, it is our

practice at Penn to recommend treatment of women with 1‐3+ nodes based on the long‐term data from both the Danish and Vancouver Trials, both of which show that the relative risk reduction in LR is the same in patients with 1‐3+ nodes as it is in women with >=4+ nodes, and that the absolute improvement in survival is the same in both groups of patients (about a 10% gain).'



I dislike being in the grey area but this helps, in the end I will need to weigh the pros and cons and the info provided by the second opinion and then make my decision.

Hi Traii , doing OK , still having some muscle aches and joint pain post chemo 6, very tired. Sounds like you had a wonderful New Year's Eve in Australia, I'm glad. It's 11:17 pm here right now, getting close. I napped this afternoon so I could stay up with my husband this evening to celebrate the New Year.

Thank you for sharing, difficult decision - Definitely sobering to reflect on what the side effects can be vs the benefits. So sorry that you are here because of previous radiation but very happy to have made your acquaintance.

You are having your next chemo on Wednesday, right? - I'll be in your pocket or on your shoulder