Radiation therapy one positive node?

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zayb
zayb Member Posts: 83
edited February 2016 in Radiation Therapy - Before, During, and After

I probably shouldn't be reading about breast cancer, but... 7 years ago I was diagnosed with T2N0 triple negative left side. I had a mastectomy, 13 nodes removed, chemotherapy and radiation. A year after my first mastectomy I had a second mastectomy on my right side. The right side was supposed to be prophylactic, but small areas of dcis were found, some high grade some low grade. I didn't have a sentinel node biopsy at the time but had good margins. Fast forward 5 years to last summer when I was diagnosed with breast cancer in a single lymph node on my right side (dcis side). Contrary to expectations it didn't seem to be related to my high grade dcis. It was low grade and highly hormone positive (95%). I ended up having all my level 1 and 2 lymph nodes removed. The affected lymph node was 3 cm but it had no extra capsular extension. All the other lymph nodes were cancer free. I also had a completion mastectomy (24x18x2 cm piece of tissue plus lots of skin removed). No cancer was found anywhere besides the single node. I had TC chemo and am on Anastrozole. My oncologist did not recommend radiation therapy. Now I am reading all these things about the benefit of radiation therapy for even one positive node. I am not sure if my case is different because I had my original mastectomy so long ago or because they did such extensive surgery and removed so much tissue after having a mastectomy. Is it still common practice to have no radiation with only one positive node?

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  • Denise-G
    Denise-G Member Posts: 1,777
    edited February 2016

    After reading what you had to say, I would definitely get an opinion from a

    NCI Designated Cancer Center.

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  • zayb
    zayb Member Posts: 83
    edited February 2016

    I am being treated at an NCI designated cancer treatment center. I just looked it up and it just received an exceptional rating from NCI for its research.


    I know there is some controversy about radiation therapy for 1-3 nodes. I just read that study about the survival benefit published in 2014. It seems pretty astounding, but the time period covered is from the 1960s - 1980s. My case is unusual since I had a very unusual type of recurrence/new primary. Maybe more similar to an occult primary but without a breast. Although I realize it is not good that it was in a node (a level one right on the edge of where my breast used to be) my situation would not be better if there had been a local tumor as well. It is just sort of confusing. Presumably if I was going to have a local e.g., chest wall recurrence I would have had it before the lymph node.

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  • zayb
    zayb Member Posts: 83
    edited February 2016

    I was looking at some studies from this site. One that looked at women from the 1960s - 1980s said there were 8 fewer deaths per 100 women at 20 years when radiation therapy was used for 1-3 nodes. That seems like a lot! Then another study, more recent with a smaller sample said the recurrence risk for one node was 3.3%, compared to 2.1% for 0 nodes. That seems really low, and not much of a benefit. I noticed in the earlier study that only 21% of the women had hormonal therapy. This is starting to bother me. I asked my oncologist if I would be getting radiation. He said no, but I didn't ask why not? Maybe I will call and ask. From reading this site it is not clear what the common practice is.

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