Considering radiation... with history of asthma?

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tshire
tshire Member Posts: 239
edited July 2015 in Radiation Therapy - Before, During, and After

So when I was first diagnosed, I immediately wanted a BMX out of fear. Then as I talked to more doctors and survivors, I thought maybe just a single MX would do (I really didn't want to do rads).

But then I talked to a doctor (breast surgeon) in another city for a second opinion, who said if I had the single MX with DIEP reconstruction (which was my plan), if my nodes were positive I'd still need rads anyway. And rads would ruin the DIEP tissue, making it rock hard. Plus, they would have to irradiate my chest wall instead of just the boob, which is more dangerous. Does this sound right?

So I thought, what if I just do a lumpectomy and SNB for now, so I can get the damn thing out? Then if my nodes are clear (like the MRI I had last week said they were) I can still choose MX/DIEP as a second surgery and avoid rads?

I congratulated myself on the brilliant plan and called the breast surgeon I'm working with in my home town to schedule the procedure. She's out but her nurse said if I'm choosing lumpectomy now that has to be my "final decision." And I have to do rads.

I plan to talk to my surgeon when she comes back next week (surgery is July 13). But in the meantime, I've thought more about rads and have an appointment with a RO tomorrow. It would certainly make the surgery portion easier. The thing is, I have super fragile lungs. Always have. Lifelong asthma, which was worse as a kid but now mostly limited to flaring up whenever I get a cold or flu. Then I get a cough that lasts for weeks, sometimes months. I seriously do not want to do any further damage to my lungs.

Plus I have super fair (redhead) skin that burns to a crisp at the drop of a hat. I can't seem to find anything linking radiation treatment to skin cancer, but it seems to have a pretty obvious potential for that to me.

Anyway, any input on this?

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  • plumster1
    plumster1 Member Posts: 270
    edited June 2015
    I am having an Lx tentatively july 23rd...still waiting on genetic tests. I already visited my RO. My understanding is there are multiple types of radiation treatments. Traditional gold standard - 5 days a week for 6 weeks whole breast, brachiatherapy (sp?) - targeted area 2 times a day for 5 days and I am having a newer type which I know is not available everywhere IORT (intra operative radiation therapy) a one shot deal during surgery. The brachiatherapy might be something you could discuss with BS and RO or see if IORT is available near you. It seems those might help you avoid the side effects that you are concerned about. Good luck and keep us posted!
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  • ceanna
    ceanna Member Posts: 5,270
    edited June 2015

    tshire,  as plumster said, ask the radiologist about brachytheraphy or interoperative radiation if you go with the lumpectomy.  Either targets the radiation to the area of the cancer instead of whole breast.  I had a SAVI device inserted for radiation and the radiation is then done twice a day for 5 days instead of 6 weeks.  Recent studies (there was just a thread about the new study on another thread on this site) have confirmed brachytherapy has similar long-term results with whole breast radiation with less skin problems and potential internal problems.  There are limitations on who qualifies for brachytherapy based on where the LX is in the breast (can't be too close to skin or chest wall) and the size of the breast.   Not every  breast center offers, but it's worth exploring another center if yours does not. 

    Make an appointment with your asthma specialist too before you decide on treatment.  They probably have experience with other patients with asthma who have BC and need radiation. 

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  • ICanDoThis
    ICanDoThis Member Posts: 1,473
    edited June 2015


    Oh, tshire, you may be my sister from another mother!
    I have struggled with asthma my entire adult life, and my radiation therapy did not touch my lungs at all. I had partial breast radiation, and the location of the tumor meant that my lungs were out of the field.
    That doesn't mean that my asthma doc would guarantee I was fine when I had a bad bout of asthma about 4 months after the treatment, but my RO showed me the set up fields and such to prove that the lungs weren't involved. Ask them for that.
    With grade 1, brachytherapy or partial breast, or intrabreast treatment during surgery are all really good options.
    Are you at a comprehensive cancer treatment center? Because many of those have really good experience with alternative types of radiation therapy.
    Don't let them push you onto a standard track. With grade 1, you have time to get the treatment that is totally appropriate for you.  And, avoiding a mastectomy if you possibly can is a great idea!

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  • BrooksideVT
    BrooksideVT Member Posts: 2,211
    edited June 2015

    I also was unsure about surgery--lumpectomy? Mastectomy? Single? Double? Finally, rather than wait for the BS and PS to get together to schedule DIEP, I scheduled a lumpectomy, just to get the thing out asap, with a pretty firm intention of following with a DIEP or two. Yes, nurse or no nurse, you can still go ahead and have the DIEP/s at your leisure. Do check with your insurance, but it is my understanding that they all have to cover the subsequent procedure.

    For me, I realized I was happy with the lumpectomy and did not feel a need to risk the sometimes considerable side effects that some women have. (Do read the DIEP threads to get a handle on how recovery works for actual BCO member women.)

    My skin is very, very fair and, like you, I burn easily. Rads works quite differently from the sun, and your RO will tell you whether you are at risk for problems. Mine told me I was not, and my skin was just fine.

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  • tshire
    tshire Member Posts: 239
    edited July 2015

    Thank you ladies. I'll be sure to ask the RO about all of this tomorrow.

    I'm planning to get the lumpectomy here in Austin, and then go to MD Anderson in Houston for consultation/further treatment.

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  • ICanDoThis
    ICanDoThis Member Posts: 1,473
    edited July 2015

    Good luck!
    I rarely come to these boards anymore, but for some reason, I've been coming more often, and have been running into your posts.

    So glad that you are being proactive and caring about all aspects of your health


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