the neoadjuvant staging dilemma

I opted to hit it with everything in the arsenal. I had a BMX (right-prophylactic) after four rounds of neo-adjuvant chemo, and then an additional two rounds of chemo before radiation. Still found some cancer in the removed lymph nodes, although size was not mentioned on the path report. But there was some extracapsular extension (node had burst open with cancer). My feeling on that is that the fine needle biopsy that was performed on an enlarged node before chemo might have compromised the node sheath and led to this. The nodes were left in place during chemo and not removed for several months after the biopsy.

Radiation was quite easy. The only inconvenience was that it was everyday (except for weekends, holidays, and a day when the machine was being serviced) for six weeks. I chose a treatment center near my office so I could make my appointments for lunch time or end-of-the-day.

There's no pain during the initial treatments, but there can be some reddening and burning of the skin towards the end. Not everyone experiences this, though, and for me it was not any worse than a sunburn.  All radiation centers will have some kind of ointment they will reccommend for you to use. I found that I blistered anyway, even though I faithfully used their suggested cream. The section here on radiation treatment will name many other products that can be substituted.

Every precaution is taken to assure minimal collateral damage to other organs. Today's radiation machines are very accurate, and the technicians use calibrations that are checked and rechecked. That said, there are some areas that might need radiation that are close to or behind a healthy organ. Lungs and heart sometimes are in the way. The RO will let you know if there is a situation like that, and I suppose you would have the right to opt out of treatment. But I would definitely speak with an RO first to find out just what your situation is.

They thought my toumour was 2 cm going into surgery...During the sentinal node they did 2 nodes-one had cancer and one had a LITTLE bit of cancer... That changed after surgery...The tumour was really 4cm and it half of my nodes that they took out.... So they skipped over the sentinal nodes.

I had zometa with chemo..With every 3rd taxol I had zometa as well. Now I get zometa every 6 months. Can I see the study you read on zometa? I would be intereste in seeing that.

Thank you!

Yeh it took some stress away from not knowing if I was going into mastectomy needing radiation or not.. Part of me feels that I should have the radiation anyway bc node was positive but the way bs surgeon puts it, if there is nothing in the nodes after chemo then radiation would just be overkill( after axillary node dissection and mastectomy) so I guess I understand where she is coming from too.

New direction.. How r u feeling

I guess u have to see what path report says since that will determine radiation. Why would they radiate if there is nothing there after chemo.. I don't think my tumor was that much smaller than yours so so it's funny to see that ur treatment plan involves the radiation after mastectomy since its not overly large but then again i dont really know anything haja.

i am very much In treatment still...so I really wake up thinking about cancer ad going to sleep thinking about it.. I will b glad to be done with chemo and then surgery.. I am told it does get easier, I just waitig until when..

I too have made lifestyle changes since diagnosis, for the better except they limit my exercise to pure walking when before this I had really gotten into a good regimen and had to leave it in the dust for a bit.. Nt that I enjoyed the exercise but especially now I would feel better doing more.

New direction.. You wrote:

(shari: There is a risk of postponing radiation the more extensive the surgery. So this also speaks for your plan. I was also told studies have shown women seem to be more happy with their reconstruction when not carried out right away. Not what made me choose the way I did but makes some sense).

I am not sure what u mean.... If I postpone radiation then does that mean my surgery will be more extensive... Or if my surgery is more extensive, then I should wait longer for my radiation... To heal and such.. Sorry for the confusion.. Do u know if there r still postive nodes after chemo.. Should one definitely get rads, or is it only recommended for a certain amount?

One thing I should add is that they were concerned about the nodes that could not be removed surgically (supraclavical)...what might they have lurking there that wouldn't show up in the PET/CT? Since the chemo still left some active cells in the removed nodes, the radiation was focused on the nodes that were left behind in the center of my chest and the axillary area that likely held more than the ten nodes that were removed. I had begged my BS to removed as few nodes as possible since I was worried about developing lymphadema.

I read article new direction.. Thanks will discuss with doctors but I guess we still have to see what happens after chemo and after surgery to make any further decisions.. Thanks a ton.. Article was very insightful. Haha still not sure where that leaves me though.

Wildurama,

I know we have pm'ed before and I really appreciate ur input on the matter. I guess we will have to see what the path report is with surgery after chemo is done. I guess it is a gray area and I already have stress and anxiety over the what ifs. I will be having alnd as well with surgery and will see what the nodes say then .. Thanks again for ur story... Helps me feel better and a little more at ease

@Shari0707 - I'm sorry about that.  I didn't recall our private messages!  I pray you get some clarity soon.  I'm sure you will!

New direction,.. Did they give u an initial clinical stage at diagnosis.. I know it's not as accurate as pathological stage but maybe it may help make a decision.. Unless u still have postive nodes, do the radiation! That's my theory.... They told me state 2 when I was diagnosed.. Based on size and positive node.. I will go wi that until I know otherwise.. Good luck and keep me posted..l

Wildrumara... I hope for clarity too.. Will get it I suppose when I have surgery... March 1 chemo done and imaging done as well.. End of march lumpectomy and alnd... Then onto rads or mastectomy or both!