To Do or Not To Do Rads? What do you think?

Look on Breastcancer.org for this article: 'Benefit of Radiation After Mastectomy Isn't Clear'.



It stratifies women according to nodal involvement (0, 1, 2 or 3 nodes). All 1,019 women in the study had a mastectomy and 0-3 nodes involved.



This study is unique in that it doesn't lump everyone with 1-3 positive nodes together and say 'some people with 1-3 positive nodes may benefit from post-mastectomy radiation'... It stratifies the subjects according to precise nodal involvement.



It isn't a be-all and end-all study-----but it's worthy of your consideration.

Certainly its your call, but having had RADS (although in 1995) because it was the norm if I went for lumpectomy - which I did. I worked while I had RADS, and chemo. I went for my rads on my lunch hour and drove the distance fine, it doesn't take long and they gave me a tub of Aloe to slather on liberally every day I went there. I had tubs of Aloe coming out my ear, I had so many - and slather as much as I could, still had leftovers!!! All these years later I never noticed anything negative about my right lumpectomy side. RADS made me tired more easily, but that improved in time.



Fast forward last Feb, dx other breast with DCIS, aggressive with small invasive, - and the option again: Lumpectomy or Mastectomy - if I chose Lumpectomy it would again be protocol for RADS - I chose not to have RADS again, even though it was not horrible, but because there are side effects that you can't see.



I had mine all those years ago, who knows if they haven't changed things a bit - but I do know that personally 2 local PS told me that I would have a problem because the skin was radiated (even though I could see no outside problem) with reconstruction after the bmx I chose as my treatment. Then I went to have autologous reconstruction and saw after the surgery that there was a difference in the skin on the right vs the left breast. I have heard of other people in the reconstruction forums who have had problems with the radiated side as well.



BUT I had no lymph node involvement - either time. This is your choice, a soft call, just giving you what I have experienced and heard about a side effect if you want to go forward with reconstruction. If I had it to do over again, I would have done the exact same thing I did. Lumpectomy, chemo, rads, and again the bmx with natural reconstruction. I chose not to go through continued lumpectomies with rads and would do the same now.



I did have HBOT (hyperbaric oxygen treatments) for 20 sessions 2 hours a day for 4 weeks to build up the Radiated skin on the right side.



Hope this helps. There is no easy answer when we ponder these things, but knowing what you may or may not be getting into sometimes helps, or at least I hope so!



It's all doable, though, and hoping whatever your choice you have support!

I think the key issue for jenjen1 is whether the one positive intra-mammary node means treating those nodes would improve her chances in that area.  That is part of the regional treatment.  

Radiation is a local-regional treatment intended to reduce the risk of local-regional recurrence.  If you can prevent a local-regional recurrence, that might reduce the risk of that recurrence eventually leading to a distant recurrence, but the main treatment aimed at decreasing the distant recurrence risk is chemo.

I understand your dilemma.
Was your tumor located in the center (not in the upper left corner of the breast)? The studies Ive come across all deals with positive AXILLARY nodes - where even one no matter tumor size would mean radiation (if larger than 2 mm). Your situation seems unusual, but I wonder if your positive node even though its at a different location wouldnt still mean YES go for it.

Age under 40 does not in itself give an answer to that question but may point in that same direction.

If I were you Id try to find out if the doctors agree this is equal to a positive axillary lymph node. If yes, then I think I would go for rads. No matter what do what feels right.

do you know the size of the lymph node and if it has extracapsulary extension. Those two things may help you make your decision as well.