Concurrent Chemoradiation

batsas · April 2017

My mom had been diagnosed with BC spread to the 1st and 4h rib. Our oncologist recommended to go for concurrent chemoradiation(30 radiations+ 4 cycles of CMF chemotheraphy(mild doses).how efficient it is to stop the spread and shrink the size of tumors.Anybody pls advice

dlb823 · April 2017

batsas, without knowing your Mom's complete diagnosis and situation, what's been recommended to her does not sound like a first-line treatment for metastatic breast cancer limited to her ribs. I would strongly suggest getting a second opinion, preferably at an NCI-designated cancer center. Here's a list: https://www.cancer.gov/research/nci-role/cancer-ce... If there isn't one within a reasonable distance from where your Mom lives, you might try calling the closest one and seeing if they can recommend an oncologist in her immediate area -- preferably one who specializes in metastatic breast cancer.

A couple of things concern me about the recommended treatment. Unless she is in a lot of pain, whatever medication she's put on should take care of any pain she may be experiencing. Because there is both a lifetime limit and limits to specific areas, radiation is often reserved for really severe lesions, seldom spots on ribs unless they are excruciatingly painful. Also, doing RT and chemo together can be extremely taxing, and chemo can lower white blood counts so that if she was to have any skin complication from the RT, healing would be impeded. I'm not a doctor, but I would absolutely suggest a second opinion, just to be sure this is the best option. Also, unless your Mom's bc is hormone negative, the strongest first line treatments for bone mets are the aromatase inhibitors -- most often Letrozole or Anastrazole, possibly paired with a CDK4/5 inhibitor such as Palbociclib (Ibrance) and a bone strengthening drug such as Xgeva -- not chemo, which even in light doses is reserved for when anti hormonal meds no longer work.

Just my first impression reading your post, although, there could be factors not mentioned -- especially if your Mom's bc is hormone negative -- that would make chemo a viable option. Even in that case, a second opinion's never a bad idea.

Good luck, and please keep us posted! Deanna

dlb823 · April 2017

Batsas, one more followup thought... Something you said above about the suggested radiation also sounds a bit "off." 30 radiation treatments is common when radiating the whole breast for early stage bc. But I think most RT done for bone pain or to stop bone progression is frequently a much shorter course -- like a week or two at most. Maybe just one more reason to be sure your Mom gets a second opinion from an onc or medical team that specializes in metastatic breast cancer.

batsas · April 2017

Thanks for the reply. We had a second opinion with an oncologist and he suggested that 2 weeks of radiation is enough, followed by 6 doses of Taxol. My mom is ER/PR+ and HER2-., also the onc, told that he will put her on hormonal theraphy once the chemo gets over.Below mentioned is my mom's diagnosis details.

Intial surgery done in 2011

Biopsy report :

Left breast mass, lumpectomy with axillary dissection; Invasive Lobular carcinoma Grade II

Measures 20 mm in dimension; Focal High grade comedotype DCIS

Nipple ; Pagets disease Axillary tissue : Metastatic disease in one lymph node

ER/PR Status Not available

Chemotherapy undergone 6 doses.

Recurrence in jan2017 ;

X-ray for chest showed normal chest ray,,

A small lesion measuring 2x1.2 cm was found in 6 degree clock posttion of left breast

Mastectomy done

Biopsy report :

Invasive breast carcinoma of no special type, Grade II

Tumor involves Skeletal muscle and margin of excision

Micro-metastatic deposit present in 1 lymph node

Vascular and peri neural invasion is present

ER + /PR + /HER2 -

After surgery PET SCAN showed results :

Lytic lesions in 1st and 4th ribs(max SUV uptake in 4th rib - 5.8)

Focal lesion in left sterni(Max SUV : 3.8)

How efficient is Taxol, will it clear the lesions from the bones.Please share your thouhgts

dlb823 · April 2017

batsas, to answer your question... Taxol, as well as hormonal meds, can heal the bone metastasis, but it will usually not totally clear the damage, which will continue to show up on scans, but hopefully as inactive areas.

Since the 2nd opinion you've gotten was so different from the first, I can't help but wonder if even a third opinion would be worth hearing. I say that because these days with hormone positive (ER+) mbc, Letrozole (an aromatase inhibitor) + Ibrance (a new drug) is often the first line of tx, unless she's done Letrozole (also known as Femara) in the past. This can be much less toxic than Taxol right off the bat. Also, I'm not a doctor, but the bone mets looks like it's pretty low volume. Unless it's causing her significant pain right now, many meds, including Taxol or Letrozole+Ibrance, will heal the bone mets w/out radiation, which can then be saved for potential use later, if ever needed.

Again, I'm not an oncologist and I don't know your Mom, but just sharing thoughts based on living with bone mets for 3+ years and interacting with many other women here and elsewhere on these meds.

All the best, Deanna

batsas · May 2017

Hello Deanna,

Thanks for your feedback.

We had switched our oncologist and he told to stop all the old treatments, radiation and chemo. He ordered for pet scan and blood test followed he told to take Letrazole tablet only which can help to slow the growth of tumor.No chemo needed anymore like that he told.

dlb823 · May 2017

You were wise to seek additional opinions. Your Mom is very fortunate to have you supporting her and advocating for her care. I hope she does well for a very long time on Letrozole, which sounds like a much more conventional treatment for her situation. If you are in the US, you might also want to ask her onc about a newer drug called Ibrance that is now being paired with Letrozole. But it may not be available yet in many places outside the US.

batsas · June 2017

Hello Deanna,

Thanks for your reply.we had a pet scan last week which showed as lesions in 1st and 4th ribs are totally gone, now only suv uptake was in left sternum(suv -6).our oncologist had already started hormone theraphy(femara) and told he ll be monthly putting bone injection (zoldria) to increase bone strength.My only worry is that he is giving assurance for survival rate as 3 years only.is there any advanced treatments available than this,, i think bone mets can be managed for very long time and she is er/pr+ and HER-..any one pls share your thoughts

Concurrent Chemoradiation

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