Radiation after BMX and pCR?

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kber
kber Member Posts: 394
edited July 2019 in Radiation Therapy - Before, During, and After

Hi,

I had neoadjuvant chemo and then a BMX last week.  I got the good news that there is no residual cancer (yay!).  My medical team is suggesting I'll still benefit from radiation therapy.  I think the deciding factor is that I'm triple negative, so hormone related therapies are not an option.

Anyone else have a similar situation?  If so, what was your course of treatment?

TIA!

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  • notdefined
    notdefined Member Posts: 286
    edited July 2019

    Hi Kber- I am hoping to get a pcr and hope to elect radiation after a unilateral-mastectomy. Did you have reconstruction at the same time as your mastectomy? I'm wondering if that will be possible? Also, do you mind sharing why you had a bilateral? I am on the fence on having everything removed, and was wondering if your doctor recommended that course of treatment?

    Hope you are doing well.

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  • kber
    kber Member Posts: 394
    edited July 2019

    Hi notdefined. My decision for a BMX had a number of factors. I had some unclear genetic test results. - a finding of “unknown significance “ that was in a gray zone. I had extremely dense breasts. I had triple negative cancer. I have a strong family history. My cancer presented extremely aggressively. I had calcification throughout the cancer breast that would have been hard to biopsy. My original tumor was large and I had lymph nodes light up on a PET scan, although they were not biopsiedat the time. Given the size of my tumor, a pCR was only about a 30% likelihood. My MO strongly urged me to consider a bi-lateral and my surgeon was supportive .

    There wasn’t a single “home run” item. More like a preponderance of factors leading me to my decision.

    I had temporary implants / tissue expanders put in at the time of surgery as “place holders”. My PS wants to wait 6 months after radiation to do the exchange to regular implants to give me adequate time to heal. I’ll also do some fat grafting at that time to round them out a bit.

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  • notdefined
    notdefined Member Posts: 286
    edited July 2019

    I'm so glad you ended up getting a pCR! Thank you so much for sharing. I have only met with my PS once, and we didn't discuss radiation. The BS is the one who told me that lumpectomy would accompany radiation, but didn't mention radiation with mastectomy. As a fellow triple negative, and having dense breasts, I really want to throw everything I can at this. As it is, I did not get carboplatin with my taxol, and I was a little upset that I didn't have that regimen (I didn't it increase odds of pCR by 9%).

    I know what you said on a different board about having several things checked off in order to be offered radiation after mastectomy, but I was wondering if I had reconstruction during mastectomy would that muddy my chances? After seeing your response, I think it would be a good idea for me to contact my BS and PS to make sure they are supportive of what I am requesting.

    Thanks again.

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  • DATNY
    DATNY Member Posts: 358
    edited July 2019

    I had pcr following multiple tumours in the same breast , one confirmed positive node and "numerous" others that lighted up on MRI.I had bilateral mastectomy following pcr (also had a mutation of unknown significance, and I was relatively young at 44).

    I struggled with the decision to do radiation. My RO was honest and told me there are no clear statistics to understand if radiation would benefit someone like me. The risks were better understood. He, however, still strongly suggested to do the cut and chest area, and was only mildly inclined to do the underarm. In the end I did everything.

    What weighted in my decision was the fact that there is a so called abscopal effect reported for radiation. I was thinking that, if there are still cells left, the rads will help get rid of them, and there would also be a small chance this will help eradicate tumors in other places.

    Also, especially for someone like me with multiple tumors, would be so challenging to inspect the whole (large) breast for pcr.

    I was hormone negative her2 positive.







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  • kber
    kber Member Posts: 394
    edited July 2019

    DATNY - I had similar advice. I ended up with not just a second opinion, but with a 4th! I kept looking for someone who would either give me something definitive, or who would tell me I didn’t need radiation. What I got was 4 docs who said I’d probably benefit and should likely do it, but it wasn’t a sure thing. I decided 4 docs being 75% sure was good enough to go forward.

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  • breast2beast
    breast2beast Member Posts: 25
    edited July 2019

    whats pcr?

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  • kber
    kber Member Posts: 394
    edited July 2019

    pCR is “pathological complete response”. It means that after chemo there was no residual cancer.

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  • Laurencl
    Laurencl Member Posts: 237
    edited July 2019

    Kber,

    Do the tissue expanders hurt? I met with a ps today and had the procedure explained. I agreed to the expanders. Wondering if they are uncomfortable.

    Notdefined,

    It was explained to me that the recommendation for radiation would come after surgery (after pathology), and that the expanders would be ok for radiation.

    Meeting with the surgeon tomorrow to confirm all this. Was not really ready for (what could be) maybe almost another year of this, but I guess that is where we are. Thought Chemo was going to be the worst part. Now not sure

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  • kber
    kber Member Posts: 394
    edited July 2019

    Hi Laurencl. Honestly I’m not sure. I had mine put in at the same time as my mastectomy. I had a skin and nipple saving surgery so there as plenty of room. I then decided I was big enough with what I had and I never experienced the discomfort or stretching of a fill. Other have said that the fills can be uncomfortable. I can say the expanders are heavy and feel unyielding. Not natural at all.

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  • notdefined
    notdefined Member Posts: 286
    edited July 2019

    Thanks for the info Launcl. I was concerned because my plan was to get a DEIP during my UMX. I wasn't sure if PS would still go that route if I was going to get radiation as well. Something tells me that would change the plan. I reached out to my BS, and he referred me to the radiation doctor to discuss. My appt is next week. It seems so odd to me that ive only met PS once.

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