Positive Nodes and Rads

Colt  - I believe the current thinking is that with 1 or more positive nodes there is a benefit to rads.  Yes, unfortunately the 1-3 is broad range but if it made it to one node then the cancer has travelled and their are risks to that. ( Having no positive nodes does not mean the cancer hasnt travelled either because it can bypass the nodes and travel through the bloodstream) Other factors to consider is the grade/type of cancer  -your wife is her2 neg and grade 1 (slowest growing) which works in her favor.  Another factor some rad oncs consider is LVI - lympovascular invasion.  I dont think a BS and MO should be advising on whether or not to do radiation - that is not their specialty.  Get 2 or more opinions from rads oncs from different facilities to see what their recommedations are. 

Colt,

I had 1 positive node (out of 18), a BMX, chemo and did radiation.  I was told by my BS that I didn't need it but frankly I get the sense that is what they typically say (they believe they got it all with the surgery).

My sense is that mine was a borderline case.  I had 3 RO opinions about radiation and really struggled with the decision.  Two of the 3 fully admitted that I was a boderline case and said they would support me either way.  One was very aggressive and said "you are 40 you need to do radiation". 

They showed me a LOT of studies with the statistics on recurrance rates for people with and without radiation and the data is a bit all over the map.  Honestly I can't remember them anymore but did post about it at the time I was going through the decision.  But basically studies showed recurrance rates anywhere from 8-30% for 1 node positive, young women like me.  Which is why it's a boderline case.  If you believe 8% you probably wouldn't do radiation (and they wouldn't recommend it).  If you believe 30% you would do it.

But there was enough evidence that my age, 1 positive node and very small amount of LVI all pointed to it making sense.  And one doctor hit the nail on the head when she told me that at the end of the day I just have to decide whether I am the type who can make a decision and move forward or if I will always be looking over my shoulder wondering if I did enough.  I knew I was the latter and decided to do it.

A couple of things - 1) all of the ROs agreed that I should NOT have my axilla radiated because of the number of lymph nodes I had removed.  So we radiated the breast area and the superclavical.  Not the level 1 or 11 lymph nodes.  According to the docs that also helped keep the risk of lymphedema lower.  They said that if I had radiated the axilla my risk of lymphedema would be as high as 50%.  And claimed that my risk having done it the way I did went up by 2% over what it is already.

2) my plastic surgeon did the exchange to permanent implants prior to beginning radiation.  That's apparently always how he does it (assuming you healed from the original surgery well).  My sense is that he really doesn't like to mess around with radiated skin and my RO tells me that it seems to be a personal preference from doctor to doctor. She sees most Sloan Kettering docs doing it that way and most NJ docs doing the exchange post radiation.  She hasn't seen a noticable difference in the cosmetic outcome between the 2 approaches. 

3) my nipple reconstruction options are now limited because I did radiation.  My PS will not do nipple implants on radiated skin.  So my only option is to do a tattoo.  I frankly don't care all that much but didn't realize that was part of the decision at the time. I am doing the tattoo in April.

I finished radiation 4 months ago and other than some tanner skin under my arm have no noticeable side effects.  I did burn fairly well at the time (worst was the 2 weeks post radiation) but am no worse for the wear.  And it really is nothing compared to chemo. 

Best of luck with your decision.

Rose

1 of 15 positive nodes.  Two consults with rad oncs - one strongly recommended but gave no statistical info and cited no studies.  The other agreed I was borderline, and said in my case the studies showed there was no survival benefit, just a reduction in recurrence risk.  With survival off the table, it became a QOL issue with me.  Did a lot of research, ended up declining rads.  Everyone's tolerance for risk is difference.  The one rad onc who agreed I was borderline said 90% of women with my dx are radiated for no reason - 85% will not recur, rads or no rads.  5% will recur, rads or no rads.  That leaves 10% of women who will recur if they don't have rads, but won't recur if they do have rads.  I was comfortable with that 10%, especially since there was no survival benefits.  Of course these stats were from 5 years ago - I'm sure they're more refined now. 

And I have arm and truncal LE anyway, even without rads.  But it's minor early stage LE - I suspect it might have been worse had I done rads, but there's no way to know that. 

You may want to ask the rad oncs about "recurrence" v. "survival".  The risks are different and that might help the decision.

Thank you!  (untying my cape and putting it away until the next Bat Light)