Plan to refuse ALND with a positive SNB

Steph...my breast surgeon told me before surgery that if sentinel nodes were positive we would treat them with radiation, not surgery. She felt that radiation was comparable and reduced the risk of lymphedema that goes along with ALND. Turns out that my nodes were negative but I had radiation anyway since I had lumpectomy. I am concerned that doctors are still doing ALND but I am not a doctor and maybe there are situations where it is still appropriate. I was relieved that ALND was not part of my plan

I'm not Stage III but did have a positive node. I knew almost from day 1 that ALND was considered automatic in my case and knew, as well, that I really did not want to go that route. In the end I did not do ALND (did do extensive RT) and have since read a number of studies that seem to support that decision. I do not lose any sleep over it. Good luck getting comfortable with whatever decision you make. None of this is easy, is it?

Steph

There is an article on this site supporting your decision.

Also

https://www.ncbi.nlm.nih.gov/pubmed/21403615

ALND is very tricky and is both operator dependent and patient dependent for good results.

Also there is an increasing body of work discussing the overall immune response one gets from radiotherapy and it's potential benefits in cancer therapy.

I understood that RT and ALND carry similar risk of lymphodema - what you really have to avoid is both together. But maybe there are other opinions?

Thank you for posting this. Very timely for me. This is my second time(other breast) around and I never knew that there was a choice between ALND and Radiation. I am confused though about there being a choice. My surgeon has said that SLN Pathology would be done at time of surgery and then if positive ALND would be done as part of same surgery. Has anyone had this done?

I have had restriction and some truncal lymphedema ever since prior mast. and ALND surgery and am fearing the same or worse with this one...let alone what to do about blood draws blood pressure monitoring, etc. To think there could be a choice is interesting. Any one actually done this?

This time imaging and pathology are suspicious but not clear cut (ER/PR pos. but no type or grade or even stage at this point.) so maybe no ALND is a possibility... crossing fingers... for us all!!!

Steph, My surgeon initially kept me on radiation and says it reduces risk and i am not stage iii. ALND is not my choice, but surgeon convinced of all the research and safety protocols it is backed with. Don't go for both together, Good Luck!!

oh and the route you described ( if SLN positive move to ALND is what happened/happens for the last 15 yearsor more really in theatre - not at unusual and still part of " standard of care"

Last 5 years are seeing more options 😊

Thank you for the information and suggestions. I hadn't even thought of a rad consult. Ill have to find another dr as my old one is no longer in practice near me.... so much to think about.Glad there is so much knowledge on this site.