Her2 positive breast cancer and radiatiion
I am Her2 triple positive. I have gone through chemo with
two conventional chemos and two target therapy drugs, one of them being
Herceptin. Two weeks after finishing chemo I had a lumpectomy with 5 sentinel
nodes removed. All margins came back clear. They now want me to have 5 weeks of
daily radiation with a 6th week of boost radiation. Before Herceptin
was discovered in 1998, chemo and radiation was not successful in treating Her2.
My question is, why is radiation recommended for Her2 now? There is no data
that shows that radiation kills Her2 cancer cells. My Dr. admitted as much and
the only research is from the 70’s and 73% of the women in the study had
hormone driven breast cancer and was not specific to Her2. My tumor was on the
left side, the two target therapies I was given, one being Herceptin which I am
continuing with every three weeks for a year, can potentially damage the heart,
so can radiation on the left side. Along with all the other side effects of
radiation, I am looking for any information that would encourage me to get the
radiation. I am seriously afraid of getting radiation. I don’t want to get
treatment that has serious side effects if it is not effective against Her2. It
seems radiation is just the standard treatment for breast cancer in general so
that is why they recommend it. But I want proof, I need proof. I am sick with
worry. Radiation did not work for Her2 before Herceptin so why do they want to
give radiation now? I need a reasonable answer.
Comments
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I cannot begin to answer all of the questions you posed....All I want to say is if you do have to have radiation, study carefully where you go...Tomorrow morning I fly to Shands at U of Florida Jacksonville to have a body scan and a CT of torso. I trust them after having horrific care here in a major city...So all I say to you is to not reject radiation for radiations sake...at Shands I went into the VERO machine 6 months ago and had no side effects and a lot of progress. It is a tricky and complicated minefield...good luck. Carolyn from Music City
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i am by no means an expert! I have been reading alot about this since mom's diagnosis, all that i have read says this treatment is best chance to beat cancer. I would recommend speaking with experts getting second opinion. Try American cancer society, moffitt , md Anderson they all have 1800#. Wish you the best :-)
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I'm right there with you mannettes. I just got my pathology back and all is clear. I assume you were on Perjeta too? My right side is involved, which lessens the heart worry, but I also question whether or not rads is truly necessary. I'm meeting with my onc next week.
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Oops. Just realized this post was originally started on Stage IV, probably in error. Maybe mods can move it?
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I've never heard that radiotherapy doesn't work for HER2+ breast cancer. I do know that chemo treats the whole body as does Herceptin and that the radiotherapy targets a precise spot and not the whole body. My lump was large in my breast and I had radiotherapy plus boosters with a bolus in one specific area. Although HER2+ is more aggressive, I think it's that it's more inclined to spread throughout your body more rapidly than other types hence having chemo followed by radiotherapy after surgery to ensure every bad bit has gone. Nobody can guarantee that every bit has gone and maybe some people are resistant to radiotherapy, but then some people are resistant to chemotherapy as well.
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Thanks to everyone who has responded so far. I'm not sure how to put this question out of Stage IV. I would move it if I knew how. Linzer, when I asked my Radiologist about heart attack from radiation damage to the heart he said he didn't know of any patients personally. But as I thought about it more I realized that if I had a heart attack 2 years later I wouldn't see my radiologist I would see a heart Dr. and maybe not even at the same hospital. So, I asked him again stating that fact and he admitted that would be true. Jmo06, I have contacted MD Anderson and am waiting for a reply. Hopefully they will find something. If not I hope they pursue research on the subject.
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manettes - send a message to the mods - they can move your thread for you.
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RebzAmy, The reason I have concerns about radiation working is because of the fact that before Herceptin came out in 1998, Her2 prognosis was poor. Regular chemo and radiation did not cure Her2. in contrast, Herceptin did work. So that is my concern. If Her2 was basically a death sentence before Herceptin why would radiation work now?
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SpecialK, sorry if I sound stupid but I can't find the Mods. -
Don't worry - not stupid! I had to look too - I have never done it, just know that is how others have done it. To do this you would find a post with a moderator comment, click on the moderator screen name, then click on the thing that says "send member a private message", then just explain that you posted content in the wrong place and could they move it for you - that should work. I linked something below that has a moderator you can click on, so saved the first two steps for you.
https://community.breastcancer.org/member/56097/profile
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SpecialK, Thank you so much. Message has been sent. -
Mannettes - I don't understand why you've been told radiotherapy doesn't work for HER2+ people with breast cancer. I've never heard that before and am wondering why the oncologist would prescribe it as part of the treatment if they knew it didn't work for us. It would be a complete waste of money and resources if that was the case. I was told that the radiotherapy was a very important part of my treatment and to help prevent a recurrence in the area that the original cancer was and also to any of the nodes in my collar bone area.
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The HER2 gene was identified around 1984, and this was followed with work by pivotal researchers, including Dennis Slamon, indicating that breast cancer patients who have HER2 overexpression and amplification had the worst prognosis. The advent of trastuzumab occurred in the early 1990s, and in the late 1990s it was shown that the incorporation of trastuzumab with standard chemotherapy improves overall survival. By the late 1990s, we had this information, and by 2000 we were using it for treatment of metastatic advanced HER2-positive breast cancer.
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Mannettes - Radiation has absolutely nothing to do with HER2. It's all about targeting that area to make sure there are no cells surviving. All women who have lumpectomies get radiation. If you had had a mastectomy you would not be told to have radiation. Lumpectomy + radiation = mastectomy.
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Even some mastectomies get radiation as well. I think that eventually there will be a targeted regimen that will perhaps be less invasive than what we currently experience, but for now, the standard of care will be as it is. I'm going to do the AC and the radiation, just wishing I didn't have to.
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linzer, Yes, I wish I didn't have to and I wish I could find any data, studies, research, etc. that shows if radiation works for her2. Un fortunately there is none. I could find the information on the chemo regimen working with Herceptin and the recommendation for Herceptin for a year working for her2 but nothing for radiation. All the data is for other types of breast cancer. As I said before, my concern is for my heart. If my cancer had been on the right side I could reconcile having the radiation without worrying about the damage to my heart. Some studies say it does and some say it doesn't, even studies dated 2012 and up. What is the truth. Who knows. It would be nice to know of any her2 survivors past 10 years. I do know that standard treatment is just that, standard treatment whether it works or not. -
Yes, I think we are at the forefront of many clinical studies that will evaluate pCR and the standard of care will change. When you look back over the history of breast cancer treatment (and others) there often was/is a slash and burn mentality. Unfortunately, it is what's *necessary* until they find out it isn't. I am resolved to the fact that I likely will be over treated. I cannot however, accept the risk of recurrence if I knew that I had something else at my disposal and did not do it. So, AC and radiation are in my future. My tumor is on the right side, but regardless, radiation still comes with possible lasting effects.
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linzer, you are right, darned if you do and darned if you don't. I hate being in this situation. I need to resolve this in my mind so I can have peace about it. -
linzer - yes, radiation is recommended after a mastectomy if the cancer was close to the chest wall.
mannettes - it really has nothing to do with the type of cancer.
I've had radiation to both sides and I'm fine 5 years out.
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There are myriad reasons why radiation can be recommended after mastectomy, including lymph node involvement, size of tumor , location of tumor, and margin status to name a few.
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I forgot to mention that radiation is all about preventing local recurrence ie at the site of the original tumour - 50% reduction.
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It's good that you are asking questions and making informed decisions about your health care. My understanding is that you can't be sure that the combination of surgery/chemo and herceptin will get all the little cancer cells. Clavicle area, deep chest, all lymph nodes, etc.... Radiation assists in targeting those cells that might not have been reached with surgery and chemo.
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Dalanno - did your RO also do radiation for your lymph nodes even though you had dissection? I had ALND as well and was hoping to avoid rads in that area since it raises lymphedema etc. If there are no nodes left, what do they radiate (if they do it)?
Thanks!
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I did not have radiation, and had a positive node. This was for a very specific reason, according to my BS and MO and the consulting RO - the node was INTRAmammary, not axillary (and not INTERmammary). According to them, there was nothing left to radiate as it was in the breast tissue. They believe the chemo, herceptin and perjeta will mop up any cells that escaped. I sure pray they are correct. According to them, I would have gotten a 1% benefit from radiation. I had already decided that I would accept a 3% or more benefit, so this did not make the cut in my mind. Good luck.
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linzer,
My Radiologist wanted to do my lymph nodes also but I have decided not to do radiation. They could not give me any data or studies that proved it would kill Her2 cancer cells. My Radiologist said there was no data out there to find. The clincher for me was the side effects. The info they gave me listed 4 but then when I read the consent form that you would sign, when you showed up for your first appointment to set you up for rads, there was a small paragraph that listed far more potential, permanent side effects and also stated, there is expected to be permanent injury to a portion of the lung rendering that volume of lung nonfunctional for future air exchange. Just ask for them to give you the consent form ahead of time and read it. Then you will be making a fully informed decision. I am at peace with my decision. Before, I was totally stressed out worrying and also worrying about the later damage as radiation damage continues even after you have finished, as that is how radiation works. Everyone has to make their own decision, this is mine.
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Thanks manettes, the thing is I no longer have any lymph nodes in level 1 or 2 of my armpit because all were removed. That's why I wonder about the radiation there. I'm going to ask at my next appt. this week. I'm still doing AC so I've got time to mull this over. I personally am of the throw the book at it mentality as that's what works for me. Thank you for sharing your story. Linda
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found this thread as I am searching for information on the effectiveness and need for radiation with Her2+ and mastectomy (assuming pCR and clear nodes). My original DX is in my signature. Seems to just be the protocol. Avoiding radiation sure would make reconstruction turn out better, it seems.
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I didn't do radiation and was HER2+. My mastectomy provided good margins and no lymph node involvement. However, my 4 tumors (3 DCIS and 1 IDC) were all relatively small. The RO I consulted with recommended no radiation.
Kendra
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bump
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hi sugarcanes, check out the nccn guidelines. Post mastectomy radiation is recommended for those with 1-3 lymph node
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