Anyone do Neoadjuvant Chemo & get radiation afterwards?

Hi Asher, I had a 2-hour in depth radiation consult last week to discuss precisely this question. It's a gray area for those of us with large tumors who have a complete response assuming that the surgery is mastectomy) They will not make a recommendation until they see your final surgery pathology report and there are many other factors they look at, including scans, type of cancer, location of nodes affected, size and stage at diagnosis, other medical conditions you have etc.

Some general points they told me: they will recommend radiation if there is any residual cancer in lymph nodes at surgery, or if you are triple negative (because it's the only available treatment other than chemo), or if there is any suspicion from your initial scans of cancer in internal mammary or supraclavicular nodes (because they don't remove them at surgery). Also with a tumor greater than 5cm, but not necessarily if the chemo kills it all.

Then it depends on risk of recurrence for your individual cancer. For me, with herceptin and perjeta they told me it was less than 10%, and even less due to having complete response to chemo. So at best radiation would decrease the risk by only 1-2% more for me. Their conclusion was that despite multiple tumors (largest 7.5cm) and many positive nodes it was safe to go either way, so I opted not to do it.

There is a clinical trial designed to figure out how much difference does having radiation make over time for those who had a complete or near complete response to neoadjuvant chemo. I was eligible since the RO thought it safe to go either way, but I declined because I did not want to be randomised into the radiation arm.

Hello ladies, I'm so glad you posted this question about rads. I'm stage 2b, with large tumor dx on April 2016. My oncologist laid it out on the table, neoadjuvant chemo (AC+Taxol), lumpectomy, then radiation, and tamoxifen for the rest of my life. I'm currently doing taxol and is having second thoughts about rads listening to the horrible things that could have happened.

My question is why my Dr. Does not perceive target therapy that may help me to obtained a complete pathology report. If I choose to have a mastectomy over lumpectomy does that mean rads is off the table. The thing is my OC never discussed any options and it's like she just follow the cookie cutters protocol because it's a typical treatment for early stage cancer. I am already in the process of seeking a second opinion from another oncologist. Any advice from you ladies?

Houston, the reason they aren't giving you targeted therapy is that you're negative for HER2 receptors. The only targeted drugs for early stage cancer are Herceptin and Perjeta, they both target the HER2 receptors, and if you don't have those they wouldn't work for you. Likewise for me, I'm hormone negative so none of the hormonal treatments would work for me.

Rads are a local treatment and reduce your risk of recurrence by 50-60% (that's 50-60% of whatever your personal risk is, so if it's 20%, rads would lower it to below 10) according to my RO. Keep in mind though that although it's a local treatment, if you have a local recurrence, it could spread before you know it's there.

My RO also explained a bit about what happens if you don't get a complete response to chemo. If there is anything left in the lymph nodes, they will recommend rads. Also, if you have skin invasion or inflammatory breast cancer, or if you are triple negative, they will want rads even if you do have a complete response, as an insurance policy like Traveltext says. If you only have cancer left in the breast but not the lymph nodes, then it depends on the size of what's left after chemo and how wide the margins are from mastectomy surgery. Ultimately it will be your decision, they should lay out all the pros and cons based on your own individual case.

Hi!

I had neoadjuvant chemo which destroyed all of the active cancer in my breast and lymph node. But, I was slated for radiation anyway because I opted for a lumpectomy. It wasn't a big deal. I got a little red, but that quickly faded once treatment was concluded.