Radiation recommendation for micromet in sentinel node

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Staceybee
Staceybee Member Posts: 72
edited June 2018 in Radiation Therapy - Before, During, and After

I have received two different radiation recommendations and would like to hear what has been recommended to anyone with a similar case. Thank you in advance for sharing/helping!

I had a right-side lumpectomy on a 1cm ILC and 1 of 2 sentinel nodes removed had a 1mm micromet. Both ROs are recommending 16 treatments whole breast, but one is recommending widening the field to cover the 1st and 2nd tier nodes while the other one is not. The one that is not recommending the node treatment cited a study and said her main concern is protecting my heart and she does not want to go chasing the nodes.

I think the study she is citing is Z0011, but I just reviewed a summary of it and am not convinced yet. Also, I should have asked, but since my treatment is on the right side, does radiation on the 1st and 2nd tier nodes risk hitting the heart?

In all, for anyone with a micromet in sentinel node, did you have whole breast radiation or a widened field to also include the nodes?

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  • Cpeachymom
    Cpeachymom Member Posts: 518
    edited June 2018

    Hi Staceybee- I did not have lumpectomy, I had mastectomy, but that darn positive node still got me rads. Chest wall and nodes, 3 fields. I don’t see how it could damage your heart if they’re doing right side... I’ve never heard that before.

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  • buttonsmachine
    buttonsmachine Member Posts: 930
    edited June 2018

    I also just had extensive rads to my right side, which included intramammary nodes, axilla, chest wall, and clavical area, and they were able to avoid my heart. Seems odd to me.

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  • ctmbsikia
    ctmbsikia Member Posts: 1,095
    edited June 2018

    I'm with the no chasing nodes Doc.  I had a smaller micro .3mm so wasn't enough to have any further nodes removed and tested.   You have a low onco score as well.  I would think the radiation technique they want to set you up for would answer if your heart will be protected or not.  I feel right or left side,  laying on your back for treatment there's probably a slight risk. This is just my opinion though, best wishes to you.


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  • Staceybee
    Staceybee Member Posts: 72
    edited June 2018

    Thank you for response. FYI they will position me on stomach. Don’t know if that matters for risk to heart

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  • gb2115
    gb2115 Member Posts: 1,894
    edited June 2018

    I had what was almost a micromet in one node...2.1 mm, so slightly larger. I had radiation to all the node areas. They didn't give me a choice, it was just the treatment planned. I was honestly glad to have it, because I didn't do chemo. I would worry that there were more cells hanging out in that area that they didn't find.

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  • Staceybee
    Staceybee Member Posts: 72
    edited June 2018

    As a wrap up to this thread I started, I had my husband speak to the RO that was recommending radiation for the whole breast only and not to the nodes - despite my SNL micromet. Now I am not one to have a man speak for me, but he is a physician, though does not deal with cancer, but I still think it brings some authority -- and I will take any help I can get right now!

    The RO listened to him and my concern about undertreating the nodes and agreed to widen one of the radiation field margins to better include the 1st and 2nd tier nodes. That makes me more comfortable. She did say that her initial approach is based on 10yr follow up of participants in the Z0011 study. Nonetheless, I think/hope I have a radiation plan that is more aggressive and in line with my treatment approach.


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  • LeesaD
    LeesaD Member Posts: 383
    edited June 2018
    I think that’s a good choice Staceybee. I had 2 of 4 sentinel nodes with micromets post BMX. My gut told me to have my surgeon go back in and do Axillary node dissection even though BS and MO said chances were slim there was further node involvement. Well they were wrong and there were 2 fully positive Axillary nodes found out of the additional 14 that were taken out. I had a BMX and Oncotype of 3. If I didn’t go back in radiation would not have been recommended and neither would chemo based on the Oncotype and those 2 positive nodes would still be there.with no treatment except hormone therapy. I ended up having chemo and rads to chest wall, clavicle and underarm. Glad you pushed and went with your gut and doctor agreed to widen field. You have one chance to get it right.
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