Is RT really necessary with one positive lymph node?

My simple answer would be, necessary? No, but after all we have been through I just see it as an added insurance policy that the beast won't return!! It is apersonal decision and there is no wrong answer. Best of luck to you with your decision. I am heading for my 5th rad treatment today. Hugs!

I am in a similar situation, stage 2 HER2 Positive, Infilitrating ductal carcinoma, tumor size 2.8 cm, in left breast, one intraparenchmal lymph node positive for metastic microcarcinoma, 1 mm. I had a double mastecomy, and am now doing breast reconstruction, and I turned down the radiation because I did not see the risks out weighing the benefits, but maybe I am way wrong. I have made some unhealthy life choices (ex smoking cigs for 20 plus years,) that made me feel like radiation was not the best option for me. Once I told my medical team I was not on board with radiation, they treated me differently. almost rude. I just started Tamoxofen about 3 weeks ago, I did a good 6 months of dose dense chemo, and just felt like I didn't want to destroy my body any more.
The DR's arent interested in discussing alternative therapies to ensure that cancer cells dont return, and maybe I am misinformed about lymph node presense. Does this mean that theres the possibility that there are cancer cells in my blood stream? I just figured, they removed my breast with the cancerous tumors, so now its all gone... Ok, I guess my post didn't really help nor answer your question, but I am also curious on the answer to this one....

I had 1 positive node (no extra capsular extension) and I didn't have rads. I did consult with a Professor in Radiation Oncology and his recommendation was no radiation. I was so happy to avoid it.

My surgeon is not in favour of axillary node clearance at all.

He said in the past it was standard practice but now he feels it just creates problems. He said most often the vast majority of cleared nodes came back negative and in some cases women were left with terrible problems with lymphodema. He said every day he feels more confident that the best practice is to monitor closely. In all of his patients he has treated this way in the past, only 2 have required further surgery for more cancerous nodes and their outcomes were no different to those women who didn't need further surgery.

This thread may interest you:

https://community.breastcancer.org/forum/96/topics/848922?page=1#post_4821872

LatinMixy, have you had the Oncotype test done on your tumors? I'd never agree to chemo without that information, particularly for micro metastases. You need to know the projected benefit of chemo before getting on board with it. In my case it would have offered minimal benefit, despite the positive node.

I'd definitely put the brakes on any plans for ALND - I posted a recent study on another, similar thread that confirms what Smurfette's surgeon has said. I had one positive node and one with micromets and neither my BS nor the tumor board recommended ALND.

As to radiation, well, I knew I was going to need it from the get go (lumpectomy, tumor very near chest wall, positive node) but still fought it (emotionally). In the end, I had one positive node and one with ITC and very narrow margins near the chest wall so it would have been, for me, stupid not to do it. I did get a 2nd opinion from an RO from another center and discussed the approach and the radiation fields extensively with both ROs and my BS. Their input was very, very helpful. In the end, I did quite well with radiation and I'm good with my decision. Chemo would have offered minimal benefit - RT offered more benefit, although more localized of course. It wasn't fun and it wasn't easy but I'd do it again in the same situation.

I've had other friends who had positive nodes after bilateral mastectomies who opted for radiation and, from what I've read, that seems like a good decision. Since you only had micromets it might be more of a toss up, however. Can you get a couple of opinions before you make a decision? Even if you have to pay for one out of pocket it might be worthwhile.

Good luck with all of this - the decisions seem to be unending, don't they?

Hello. I am struggling with the decision too. I have triple negative infiltrative ductile carcinoma stage 3c grade 3 with lymph node involvement (also BRCA1 positive). I should say had. I have been through chemo and a bilateral mastectomy with tissue expander placement and I had a pathological complete response to the chemo. I am highly recommended to have radiation therapy to my chest wall and lymph nodes to be sure there are not cells hanging out that were missed. I don't want to refuse it and start back at square one at some point, but I don't want to go through it if its not necessary. I guess there is a controversy about weather it is needed in people with pathological complete response. Any suggestions?