Radiation for ER-PR-Her2+ women? Yes/No?

Sam - yes I had neoadjuvant TCHP, then surgery. Even though the surgeon got 'clean margins', there was no real questions about not having rads. I had 25 sessions (5 weeks - 40 gray). Luckily I didn't have to have a 'boost'. Since I has personal experience about 'rogue' mini-micro cells escaping even though there were "clean margins" and showing up later, I didn't argue. And I was 70 at the time, and I made sure to have the discussion about what's relevant to giving me the best quality of life.

Actually rads was the easiest of everything. It took more time changing my clothes than getting zapped. I drove myself and never had any problems - just increasing fatigue as time went on.

Then yes, I did have the balance of the year of Herceptin (17 rounds total) but did not continue the Perjeta. I had lost 60 lbs with the chemo and really didn't need to loose any weight to start with. Maybe TMI, but the Perjeta gave me fierce diarrhea.

Good luck with your choices.

Sam,

It's pretty impressive that you ran a marathon with undiagnosed breast cancer; I had a friend tell me just yesterday over lunch that she was in the best shape of her life at the time of her diagnosis. What amazes me always is that few of us have any sense of the monster that has invaded our bodies--I surely didn't!

My tumor was behaving very aggressively right after diagnosis and an MRI showed that it had invaded the nipple two weeks after the 1.5 cm biopsy measurement. So in two weeks it had more than tripled in size, at least in one of the three dimensions measured. I had chosen BMX to avoid radiation but suddenly I qualified for Perjeta AND radiation! I had the best result possible, a complete response, as you did. I was bothered by the fact that even before I had surgery, I started my 7th cycle and it was Herceptin only, so I asked why, when my MO didn't know I'd had a pCR? When I inquired, as I remember, he pointed me to the Tryphaena Trial as the reason he did not continue Perjeta.

My MO felt that given the aggressiveness of the tumor (not unusual for HER2+), he "didn't want me to quit now." I believe that oncologists are really working to not over-treat in this day and time, but if there's some factor that is of great concern, they will be more aggressive. In your case, you are young and they want you to live a long time and in my case, the fact that it got to the nipple, it changed the game. Unlike our ER+ sisters, even though they suffer with estrogen suppression, they have more options than we do if our treatments do not succeed.

I had six weeks of radiation, with five boosts. Like MinusTwo (best username ever!), I found it to be the easiest part of my year's worth of treatment. Sure, I was lobster red (even the rad techs winced daily) because I'm very fair skinned, but it was not accompanied with the pain of a sunburn. I wanted to know I'd done all I could and all that was recommended.

Today I had my last Herceptin. One year ago, it was hard to imagine where I'd be and how I'd be feeling at this point (or in my darker moments, would I be alive?). Sure, I look like Dash from the Incredibles, but I'm very much alive and not wearing a wig! I can live with that, even if my hair is growing at a snail's pace. Next up: Nerlynx.

I thought if one have bmx and no nodes are involved, there is no need for rads

I didn't get radiation for my her2+ tumour 10 years ago. I really didn't want it because my family has a history of radiation being used recklessly back in the 50s and I grew up with a bit of a phobia of it. My breast was full of DCIS so I had to get a mastectomy, and so there was no question I would avoid radiation for my 1 cm node-negative cancer.

However.....I was just diagnosed with a recurrence, which is highly, highly unusual ten years out. My doctors are all shocked, which should be very comforting for folks to read because it shows they just never see it. So please bear that i mind for what I'm about to say next: My oncologist thinks the surgeon left behind a bit of tissue with DCIS in it. I have been hearing about preliminary research suggesting women with DCIS have better survival rates if they opt for lumpectomy and radiation versus just mastectomy, and I have been really regretting my decision back then. My current oncologist said radiation would have reduced my rate of recurrence by 20 percent. That's not a huge amount, and there's just no way of knowing whether radiation would have changed anything for me. But you might want to talk this over with your doctors. I will be getting radiation this time (and my prognosis is excellent, btw! Mine is just one (very unlucky) experience and one opinion, but I hope it can help in some way.

SamRans- did you opted for rads or not? I went with my docs suggestions and I am. It doing rads but some posts here make me worried that skipping rads increase recurrence even though I did bmx and no lymph nodes were involved. I hope we all do the right thing.

I had a mastectomy and both my MO and RO agreed that radiation would reduce my chances of recurrence. Also because I was only 35 at diagnosis we all agreed that it was best to just "throw the book at it". It's possible I was over treated but I didn't have any nasty or long lasting side effects from the rads and my mind is at ease knowing that I did absolutely everything I could to treat it.