no radiation after pathological complete response

Hi Rainy,

I had to make the same choice. We had assumed I would get rads because of the large tumors and positive nodes, but after surgery it turned out the chemo wiped everything out. I was not keen on getting rads because of the side effects, damage and delay to reconstruction, high risk of lymphedema etc. After extensive consultation the radiation oncologists at my cancer center said I could go either way, and offered me participation in the same clinical trial as you mention. I declined because I was not willing to be randomized into the radiation arm. I am 37 and they were tempted to recommend rads because of my age, but they looked at a bunch of studies that showed age is not a factor in recurrence.

They explained that whatever your risk of recurrence is, rads will lower it by 50%. For me they put the risk low because of the PCR and because I am getting a year of Herceptin/Perjeta on top of the chemo. So for me the benefit was not worth the side effects. They did say that even with a PCR, they will always recommend rads for someone who's triple negative because it's the only weapon they have other than chemo (no hormones or Herceptin etc) so rads make a bigger difference in the recurrence rates for tnbc. But ultimately I think it depends how high your personal risk is and how much risk vs side effects you're willing to put up with.

Hi!

I had rads after neoadjuvant chemo primarily because of the size of my lump (5 cm+). My pathology report found no active cancer, but my team recommended rads because my lump was so big and my cancer was so aggressive (Grade 3, HER2+). If my lump had been smaller, say 2 cm., my doctors might have been less keen on rads.

I'm in a similar dilemma as a TNBC woman. I'm having adjuvant chemo (4 AC+ 12 weeks of Taxol) so can't look to a PCR; however, all three nodes were negative and my 2.2 cm tumor barely meet the requirement for Stage II. DCIS was found in the margins at the first lumpectomy so I had a second lumpectomy to remove that and the surgeon got clean margins.

I'm much older than you at 62 and BRCA negative. Unfortunately my tumor was in my left breast raising more concerns about heart damage. I developed severe cellulitis ultimately requiring two weeks of daily IV antibiotics when the surgeon drained a seroma at the SNB site. I developed mild hand-foot syndrome on my left foot with the AC and a tiny clogged oil gland in my eyelid meant an infection bad enough to delay the start of my Taxol by two weeks.

With my skin seeming very vulnerable, what will happen with my entire F-G cup breast is irradiated? For my specifics, radiation only affects local recurrence with little to no impact on overall survival, but I'm obviously not eager to have a recurrence resulting in a mastectomy. If I have the radiation and still have a local recurrence, I know irradiated skin presents challenges with reconstruction. I'm also troubled by radiation oncologists seeming to gloss over long-term risks. I was discussing with my MO how they typically only see you for a couple of months, but many on our forum report ongoing or permanent problems related to radiation. This decision it's a challenging one because with TNBC, it's the metastasis to vital organs that kills you, but no one wants the risks and angst of yet another surgery for a local recurrence either. A crystal ball would certainly be helpful!

Lyn