Radiation Decision...

MarS676 · January 2013

I had a BMX on December 16 with a Sentinel Node dissection. The pathology report indicated a complete pathological response to neoadjuvant chemotherapy and no lymph node involvement. I saw a RO today and we discussed my need for radiation. I had met with her a few months back and at the time she felt that based on my PET scan and Breast MRI results as well as the clinical response I was having to chemotherapy she didn't feel I needed radiation but she wanted to follow up with me after the BMX to review my final pathology report.

Today we discussed statistics and medical studies for a long time and she told me that she felt that I do not need radiation but that she needed to discuss it with the department chair. It turns out that the department chair disagreed with her. She felt that since I only had a sentinel node dissection there wasn't a big enough sample to rule out any rogue cancer cells. I feel so defeated...the main reason I chose a BMX was to avoid radiation. Both my medical oncologist and breast surgeon feel that I don't need radiation but they wanted me to see an RO to be on the safe side. My RO suggested I get a second opinion at a different hospital since there was a difference of opinion. I don't know what to do, I just want this all to be over, I'm so tired of having to make decisions.

wildrumara · January 2013

I don't have a lot of time to respond to you the way I would like to right now, but I have been in your shoes and it sucks! I did have two positive sentinel nodes though. I did not have radiation, but I did have an ALND. Besides the two nodes, I had no other prognostic indicators for radiation. Im a little surprised you only had one node removed??? Hmmmm? That is a tough one. I can only tell you that at the teaching hospital where I was treated (which is head of the NSABP) the RO said "no" to radiation, but the doc across town at the other teaching hospital, recommended it.

You didn't mention your age......? I was 42 at the age of diagnosis. PM me if you have any other questions......I will be back on-line later.

Alicethecat · January 2013

Hi Maria

Everyone is different but in case this helps you...

Like you, I had a 3cm tumour and I'm also relatively high risk - HER2+ - rather than triple negative. No lymph node or vascular invasion. Please see my stats below.

I've had/am having the whole caboodle in the UK - surgery, chemo, rads and Arimidex. We are not bound by cost here.

If the doc at the other teaching hospital thinks you should have rads, why not have a chat with her about it?

Good luck!

Alice

cider8 · January 2013

I was able to avoid radiation because I had clean margins on my mx, rumors smaller than 2cm, only one positive node with ALND. I didn't want rads, mostly for QOL, and knowing I was in the grey area. My RO agreed, said it wouldn't benefit me.

Then over a year later I had some tissue removed during breast recon revision. Doc sent tissue to pathology and found microscopic amount of IDC. After determining the IDC was residual, not recurrent, I'm now doing rads.

Mine was a fluke and surprised everyone. I choose the same if I had to do it again. I had aggressive chemo and didn't want to be aggressive with rads if there wasn't a good reason for it. I don't want aggressive treatment as a precaution, I want a good reason! I just happened to get my good reason a year later.

SpecialK · January 2013

I was originally a lumpectomy candidate but elected BMX. My SNB was originally thought to be clear in the operating room but I did have a micromet found on post-op pathology. I had a complete ALND five weeks later which found a 6mm cancer further up, but the other nodes removed were clear. Both my BS and MO did not feel I needed rads, and they are forward-thinking but conservative. I am glad that I avoided rads even if it meant that I had additional nodes removed, but there will always be a bit of doubt as the NCCN standard now would include rads but not necessarily the ALND. It is hard when there is no clear cut answer and you have to go with a "majority rules" situation.

QueenKong · January 2013

I researched this same topic and found discussions on the forum boards of this site that lead me to the conclusion that I would get the rads. I see you are triple negative too. Let me see if I can find one of link. I may have saved it as a favorite topic...hold on....

QueenKong · January 2013

HA! I did save it!! This was a discussion for complete response and triple negative regarding radiation:

http://community.breastcancer.org/forum/72/topic/788032?page=1#idx_10

MarS676 · January 2013

Thanks to all for your helpful replies, I have decided to not do radiation. After speaking with my MO, BS and RO who understand my particular situation best I know that I am making the right decision. The RO who suggested I get the radiation is someone not familiar with my situation who simply read my pathological report and noticed that only 2 nodes were removed. She felt that since that wasn't a big enough sample I should radiate. Since being diagnosed my MO and BS were confident that if I have BMX I would not need radiation because of the scans I had before beginning treatment all showed no node involvement evident. When I met with my RO for the first time, before surgery, she also had the same impression. I feel at peace with my decision and know that I will be monitored closely for years to come, if there were any rogue cells we will deal with them when they decide to show up.

wildrumara · January 2013

Hi Maria - You sound like you have made a very logical decision! I remember when I finally made the decision NOT to do radiation, I felt at peace. I decided that I had to trust my team (who made the final recommendation for no radiation) and not the team from the competing hospital across town who were not vested in me like my doctors were. There is a time when you just have to trust and move on. All the best to you!

Radiation Decision...

Comments

Categories