Radiation necessary in an early stage cancer

 zeamer3 wrote: "A lead apron is ineffective against the radiation that is used for treatment.  Aprons are used in xray procedures due to the low energy of the radiation and the tendency of this type of radiation to scatter.  The radiation used for treatments, however, is high energy and does not scatter.  It will pass straight through a lead apron."

You're joking, right?  The kind radiation used for treating breast cancer "does not scatter"?? Well if that's true, please explain information to the contrary contained within the following journal articles.

Am J Clin Oncol. 2006 Feb;29(1):80-4.

Does breast size affect the scatter dose to the ipsilateral lung, heart, or contralateral breast in primary breast irradiation using intensity-modulated radiation therapy (IMRT)?

Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA.

PURPOSE: To evaluate the relationship between the primary breast volume and dose received by the ipsilateral lung, heart (for left-breast cancers), and contralateral breast during primary breast irradiation using intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: Sixty-five patients with breast carcinoma were treated using 6-MV photons with IMRT technique using the Eclipse Planning System following breast conserving surgery. All patients had a treatment planning CT scan. The primary breast, ipsilateral lung, and heart were contoured on the axial CT slices. The primary breast volume was calculated using the Eclipse Planning System. The mean ipsilateral lung and heart doses were obtained from the dose-volume histogram. The contralateral breast dose was measured using paired thermoluminescent dosimeters (TLDs) placed on the patient's contralateral breast, 4 cm from the center of the medial border of the primary breast irradiation field. RESULTS: The mean dose delivered with photons to the primary breast for all patients was 49.97 Gy. The mean volume of the primary irradiated breast was 1167.9 cc. As a percentage, the mean ipsilateral lung, heart, and contralateral breast doses were 11.2%, 6.1%, and 7.2%, respectively. The primary breast volume positively correlated with the contralateral breast dose (P < 0.0005). There was no significant correlation between the breast volume and the ipsilateral lung or heart dose (P = 0.463 and 0.943, respectively). CONCLUSION: This study suggests that the primary breast size significantly affects the scatter dose to the contralateral breast but not the ipsilateral lung or heart dose when using IMRT for breast irradiation.

PMID: 16462508 [PubMed - indexed for MEDLINE]

Radiother Oncol. 1996 Jul;40(1):69-74.

Active minimisation of radiation scatter during breast radiotherapy: management implications for young patients with good-prognosis primary neoplasms.

Department of Radiation Physics and Radiobiology, Hammersmith Hospitals Trust, London, UK.

BACKGROUND AND PURPOSE: Radiotherapy is used to reverse or prevent local tumour growth but is also a carcinogen in its own right. A recent audit of post-radiotherapy second malignancies in this institution revealed a striking preponderance of tumours originating near the outside edge of the treatment field. Since this finding suggests the existence of a critical subtherapeutic dose range predisposing to tumourigenesis, we attempted to define and reduce this radiation scatter dose. MATERIALS AND METHODS: We undertook a dosimetric review of 6 MV scatter from a linear accelerator in sites matching the putative tumourigenic region, and then extended this analysis to patients and tissue phantoms. RESULTS: A wide range of radiation scatter doses was confirmed-for example, doses 3 cm from the field edge varied from 1.7 to 22% of the therapeutic dose depending upon the field parameters. Scatter doses were then assessed in a sample of eight patients undergoing standard breast radiotherapy. Contralateral breast sites 4-12 cm from the midline received 4-10% of the therapeutic dose, or 200-500 cGy for a 50 Gy treatment, approximating historical estimates of the tumourigenic range. The deep component of this scatter dose from medial field breast irradiation was reduced 19% simply by replacing the 15 degrees medial tangential field wedge with a 30 degrees lateral wedge. Other manoeuvres which reduced contralateral breast dose by up to 46% included making the posterior field edges co-planar and shielding the breast during medial field irradiation. CONCLUSIONS: These results suggest that the risk of radiogenic second malignancies could be significantly decreased by careful attention to the treatment details. Greater awareness of these measures may prove particularly relevant to the conservative management of young patients with good-prognosis breast neoplasms such as ductal carcinoma in situ.

PMID: 8844891 [PubMed - indexed for MEDLINE]

I have been doing more research on this topic and have found several studies that do say that there is a definite difference between recurrance rates for those radiated in early bc compared with those not radiated. No wonder the stats and reports on medical issues are so confusing, even to the medical community.

That is why I think it is important to do your own homework and decide what makes sense to you.  However, I agree that the stats are meaningless when it comes to the individual.  Like zeamer says, for that person the chances are 50/50.  And keep in mind that 25% recurrance chance is the same as 25,000 individuals out of every 100,000 women recurring when they are not receiving rad tx.  The numbers I found for the US show that almost 200,000 women will be making this decision, every year.  I think that is why docs consider it a standard recommendation. 

When my rad onc was going over the possible long terms se of rad, she pointed out that the stats were from women who received tx 15-20 years earlier.  Radiation has been refined dramatically since then.  And when she said that most of the heart problems show up 15-20 years after tx, I had a smile on my face, thinking that I could still be here for that to happen.

In general (that does not mean all)  But In general almost every surgeon seems to say rads are necessary after lumpectomy.  I know 100% that my surgeon would have said Mariekelly needed rads.  He said I did when we thought mine was just 1.5cm of DCIS.   Even when my IDC was less then 2mm he still said rads. (I had a BLM instead)

That is the reason this thread was started

"Radiation Necessary in Early Stage Cancer"   As so many Drs say it is Always Necessary

My Surgeon also said that I would not be risking ANY SE to my Heart or Lung years from now.  Which I believe is a false statement.  There is Risk.  And this was my Left Breast.

(He also poo pooed getting LE from a SNB - I knew he was wrong there too.- I will find out tomorrow if I have LE of the trunk)

 Pam

And I should add.  With My health insurance provider & group here...I was to see my Surgeon only.  No one else.  I pushed several times to visit at least with an Onco & they said 'We dont do that'  I pushed again & they said...NO.  I tried to see a ps before hand too.   Thats not normal either.   So I was to make all of my Decisons for my Initial treatment on my BS advice.   Who Said Rads were for sure indicated.  At the time I assumed that he was going with knowledge based on what the Rad Onco would say to me also.   My BS was totally against my Choice of having a BM.  It really made things difficult.  Its why I have a Lumpectomy scar that may effect my Reconstruction on my left side.   My PS told me today that of all the bs he works with.  The one I had never wants to remove a breast.

Pam

Zeamer wrote:

"I aplaued your ability to not live in fear of recurrence.  But that is not the case for everyone.  The percentages you quoted might be too high of a risk for some women."

Actually, I think I was wrong, in those percentages that I quoted you, from MarieKelley's June 21 post. I went back and re-read it. It's not 61%/no recurrence, 39% /recurrence, without radiation. From just one of those studies, it reads:

"CONCLUSIONS: A local recurrence rate of 6% at almost 4 years median follow-up suggests that it may be possible to avoid adjuvant radiotherapy in a subgroup of largely screen-detected, node-negative patients with invasive tumours less than 1 cm, in whom adequate local excision is performed. Further follow-up is required to substantiate this. Copyright 2002 Elsevier Science Ltd. All rights reserved."

You can all go back and read the rest of MarieKelley's studies, that she posted on June 21.  Please do, go back and read that post.

I think that I got that 61%/no recurrence, 39% /recurrence from my radiation oncologist. In fact, now, I'm sure that I did.

I brought up to her, this study, that I read right here on Breastcancer.org. A 2006 Austrian study, saying the radiation didn't help, at all, in early stage breast cancers. Although, still, the headline, said "There's no group that breast radiation does not help." Even when this study "proved" that if you did not have the radiation, 4% chance the breast cancer would recur. If you did, 2%.

But wow, as MarieKelley said, in % terms that's a 50% decrease.  With the radiation. In real terms, it's meaningless. When you take into account ALL of the potential SEs.

You brought the point up of Not-For-Profit Hospitals vs For-Profit ones.  

I was treated, here in Seattle, at the Seattle Cancer Care Alliance/University of WA Medicine. Ha, one of the top Not-For-Profit hospitals, in the United States. They have an excellent Leiomyosarcoma treatment center. And an excellent Breast Cancer treatment center.  

Although, at the SCCA, I had to walk out of the CT SIM appointment,  for my breast radiation, after refusing to sign, the consent, to get away, from them. 

I had just "gone along," because I was so confused, but in the end, I just said, "NO. I am not going to sign this consent. I'm sorry for wasting your time." And literally, just walked out.

And felt SO LIBERATED.  

Although, what really happened, in my case, was that when I initially met with the Radiation Attending, I had all of these doubts. And she told me, "Just start, the radiation. And if it's not for you, quit."

Then, it was the Resident (SCCA/UW is a teaching school) came to get my consent, and I told him what the Attending had said. And that's when the shit, hit the fan. The Radiation Attending came back, saying, "If I wasn't 100% committed, forget it." 

Ha. A total 180, on her part. That is NOT what she had said to me, before. 

That's when I walked out. I didn't want to do it, anyway. I had just been frightened, into doing it.  

I don't think that ANY of the medical professionals, and from what you said, including you, are "in this" for the $. Like you said, you're a Health Care Professional, you can get a job, doing anything. You're qualified. Just like MarieKelley.

But, it's just ... working out, this way.  

IMO, this breast radiation IS a big business.  

For  not much, value recieved.

MarieKelley and Zeamer. I want to applaud both of you for this debate. I think you will both give anyone preparing for radiation food for thought. I just wish I had read this before my treatment. I had a 1.6 tumor with wide clear margins and no nodes, and everytime I kept questioning why I needed radiation they just kept saying don't worry, you will be fine. I had meltdowns for weeks concerning this treatment, and I still feel I did the wrong thing. My meltdowns were not explainable except that maybe, subconsciously, I knew it was wrong for me. Oh, how I wish I had listened to that inner voice because I do not worry about BC returning, but I do worry about the long term effects of rads. I have totally changed my diet and exercise daily, and I am in a much healthier mindset than I have been in years. I refused to go on the drugs. I still get angry just thinking about taking Arimidex. I feel that I can balance my hormone levels naturally, and my blood tests are proving this so. I too felt liberated when I finally made this decision, even though the doctors and nurses trying to scare me into using the drug. I just think it is asinine to put someone on a drug that has serious side effects for a 5% advantage. I can buy a lot of vitamins for the cost of that stupid drug, and feel not worry about the long term effects of them.

Now my blood is beginning to boil because I still get so pissed off about the fact that we are all treated with the standards, no matter who we are. The big business of cancer is not treating us as patients but as statistics. My hospital is for profit, so they probably looked at me with $$$. Even though I have good insurance, since my treatments went from one year into a new one, I had to pay the deductible twice, as well as a copay for every treatment. This damn treatment has cost me thousands and I still do not feel it did me any good.

We need to change our whole care system to a not for profit business with price standards throughtout the country. We do not need the government to run it, or socialized medicine, we need to control the cost. Then people will not be subjected to unnecessary treatments and maybe they will get about the business of preventing diseases instead of just treating it.

I tried to get my doctors to give me a program for diet and exercise, but all I got was a prescription. I finally found a holistic minded chiropractor who is helping me. I do have a lot of respect for my doctors. They were all caring women, who I believe wanted the best for me. But they are not trained to think outside the box and because of litigation fears, they cannot. We need to clean up this system and stop killing people needlessly.

Natsfan,

I'm in total agreement with you about the wisdom of never trusting in physicians 100% unless and until you've personally done your own research. I've been an RN for 22 years (and a respiratory therapist prior to becoming an RN), so I've had many, many years of working along side doctors of many different specialties. The biggest mistake any patient can ever make is elevating them to the level of, as you put it, a "demigod", and assuming they never make mistakes in judgment or action.  They are first and foremost, very human just like everyone else...and mistakes in the decisions they made and treatment they prescribe occur far more often than the general public realizes. 

There are many very good doctors but unfortunately, also many very bad ones out there...and a whole variety on the spectrum between the very good and very bad. The general public as patients has a very limited ability in being able to recognize the differences between them. Aside from a doctor who is blatantly rude and inconsiderate, or one who repeatedly blows off legitimate patient concerns and thus angers the patient, most patients are clueless when it comes to recognizing whether or not they're recieving the proper care for whatever ailment they're seeing the doctor for. Some vastly overtreat, some undertreat, some treat incorrectly, some misdiagnose and some fail to diagnose. It's almost impossible for anyone (other than those medically educated themselves) to ever really know if the treatment, diagnosis or advice they're recieving is correct...unless they do some research on it themselves.

Personality should never be the basis for judging physician competence. Some of the most obnoxious doctors I ever met were also the most compentent and I would trust them with my life. On the other hand, some of the sweetest and most pleasant are in actuality, the most dangerous and incompetent.  And contrary to what many tend to believe, local or national physician prominence, medical specialty certification or involvement in clinical trial studies and/or other research isn't always a reliable, foolproof indicator for picking out the best doctors either. 

I'm sorry about your mom, Natsfan. I have had a friend with a similar story...first a mammogram reading that missed a lump which in retrospect, was clearly visible on it and then repeated visits to a doctor over the course of nearly a year who kept saying it was just another of her common fibrocystic lumps until another mamogram was finally ordered.  It was an aggressive cancer and by the time she was finally diagnosed and treated it was far too late. She too had complete faith in her doctor and never questioned his advice until the lump became so large it was obvious that it had to be something other than just a cyst. She died of metastatic disease about 5 years after she first noted the lump.  Unfortunately, we were living on different sides of the country and not in frequent contact while most of this was happening early on and I was unaware until after she had already been diagnosed. If I had known, things might had turned out differently for her.

Jaydee,

Most hospitals in the US that care for cancer patients also have those same weekly meetings where physicians from different specialties areas that treat cancer gather and discuss the treatment plan. They usually consist of one or more medical oncologists, radiation oncologists, surgeons, pathologists, radiologists and sometimes plastic surgeons, all gathered together to make a decisionn about the best treatment for a particular patient.   Years ago I used to coordinate those meetings - gathered up medical records, radiology films, copied journal reports and various other bits of pertinent  information to be passed around among them, arranged for the lunch food to be delivered and made sure the patient was available for examination and questions if that's what they wanted. 

The consensus of opinions in these meetings is not always unamimous, so there are  sometimes those who disagee with the majority.  From my experience, the majority always voted to proceed with standard of care treatment and a patient would not likely ever know that one or more of the care conference participating physicians were not in agreement with the majority because patients were never allowed to sit in on these discussions. If patients were there at all, they were there only to be examined and were never actually in the conference room. In all honesty, and only in my personal experience in having attended so many, these meetings are more of an educational experience for the doctors as opposed to a bonafide discussion/debate on potential alternatives to the standard of care.  They literally never stray from recommending whatever the standard of care happens to be at that moment in time and whatever opinions to the contrary were just sort of thrown out there as a matter of interest only.

Possibly things are done differently these days (it's been about 10 years since I did this )and maybe patients are sometimes included now - although I doubt it because I was never invited to the one 4 years ago when I was one of the patients being discussed. My point being though, that just because there's been a meeting of the minds doesn't necessarily mean that each and every one of them agreed on what the best course of treatment should be, nor that it's actually what's best for the patient as an individual.

Apropos, of NOTHING.

Last Friday night, June 28, I went out to my garage, and slipped, on some water that had been spilled from my daughter's cooler. She'd just returned, from camping. 

I went down, HARD, on the cement. I just didn't see it. And totally screwed up my foot. All of my left toes, totally bruised.  Four days, later, I'm STILL limping.

Which just kills me, because walking, is what keeps me sane. It's killing me, not walking. I normally walk, three miles a day.

Yet.

I could have gone out to the garage, and slipped on the water, and gone down, and hit my head and died. 

My point?

Life is random. 

I'm not going to make my life, miserable, trying to prevent a recurrence of a 2cm IDC ER+PR+, HER- cancer. With all of these ... "treatments." When my SNB was negative, and I had WIDE Margins, on my lumpectomy. For my 2cm IDC.

It's just not worth it, to me. 

Ha, I'm just living for NOW! WITH my breasts!

What are we all doing, here?  What are you all doing, here? Do you think that if you treat the hell out of your breast cancer, you're going to live, forever?

I guess, you do. 

Ha. I don't. 

Anything can happen. Anytime.

The objective of radiation therapy to the breast is to kill cancer cells that could otherwise persist after therapy and cause breast cancer to relapse locally in the breast, surrounding chest wall, or axilla. Radiation therapy uses high energy x-rays to kill cancer cells that remain in the breast or surrounding lymph nodes after surgery. Radiation therapy is almost always utilized as part of the overall breast-conserving strategy because radiation decreases the risk of local cancer recurrence and improves survival. Radiation therapy is delivered to the breast and surrounding lymph nodes from a machine outside the body and is called external beam radiation therapy. Treatments are typically given daily over a 5-6 week period and additional concentrated radiation treatment, called a boost, may be given directly to a smaller area of the breast where the cancer was found.

Side effects from radiation therapy may include a swelling or heaviness in the breast, sunburn-like changes in the skin, and fatigue. Changes to the breast and skin usually go away in 6-12 months; however, in some women the breast may become smaller or firmer following radiation therapy. The size of the breast and the woman's desire for breast reconstructive surgery are important considerations that should be addressed prior to receiving radiation treatment.
Ductal Carcinoma In Situ (DCIS)

Patients with DCIS treated with mastectomy do not need treatment with radiation therapy. Radiation therapy after a lumpectomy decreases the risk of cancer recurrence. In one clinical study, 818 women with DCIS and negative surgical margins were treated with breast radiation or no further therapy after a lumpectomy. Eight years following treatment, the recurrence of invasive cancer was 3.9% for patients treated with radiation therapy and 13.4% for patients not treated with radiation therapy.
Stage I Breast Cancer

Patients with node negative stage I breast cancers treated with breast-conserving surgery utilizing a lumpectomy are currently recommended to receive additional treatment with radiation therapy. This recommendation is based on 4 clinical studies that directly compared lumpectomy to lumpectomy plus radiation treatment. These studies found that patients treated with the combination of lumpectomy plus radiation had a superior clinical outcome. Other clinical studies have demonstrated that patients treated with lumpectomy without radiation are more likely to experience cancer recurrence than women treated with the combination of breast-conserving surgery and radiation.

Standard radiation therapy following a lumpectomy consists of a limited dose of radiation (50 Gy) to the entire affected breast. While this treatment leads to long-term outcomes similar to those from mastectomy, women under age 50 experience higher rates of local recurrences following this treatment regimen compared to their elder counterparts. Researchers have theorized that an additional boost of radiation aimed only at the area from which the cancer was removed would reduce the rates of local recurrences, especially in younger patients.

The European Organization for Research and Treatment of Cancer conducted a clinical trial evaluating 5,318 women diagnosed with stage I or II breast cancer who had undergone a lumpectomy followed by the standard dose of radiation. Approximately half of the patients were given an additional small dose of radiation (16 Gy) to the area where the cancer had been located, while the other half received no additional treatment. Data indicated that the additional dose of radiation to the site of the removed cancer reduced the overall rate of a local recurrence by nearly 50%. Women 40 years old and younger exhibited the largest benefit, with local recurrences occurring in only 10.2% of patients receiving additional radiation, compared to 19.5% of those receiving standard treatment. Overall survival rates and the development of distant metastases were similar whether women received an additional boost of radiation or standard therapy. Side effects including cosmetic results and fibrosis (formation of scar tissue) were not affected by the additional radiation.

Patients with stage I node negative breast cancers treated with mastectomy do not typically require additional local treatment with radiation therapy. Some patients treated with mastectomy may however have an increased risk of local cancer recurrence. In these cases, the role of radiation therapy to prevent local cancer recurrence should be discussed with the treating oncologist. Node negative cancers at increased risk of local recurrence include cancers that involve the margin of resection.
Stage II-III Breast Cancer

Patients with node negative stage II breast cancers treated with breast-conserving surgery utilizing a lumpectomy are currently recommended to receive additional treatment with radiation therapy because radiation decreases the risk of local cancer recurrence and improves survival.

The role of radiation therapy following mastectomy in women with stage II or III breast cancer is somewhat controversial. An analysis of several clinical studies begun before 1985 found that radiation decreased the risk of local cancer recurrence by 67% and decreased the risk of dying from breast cancer by 6%, but did not improve survival. Survival was not improved because patients treated with radiation died for other reasons. These deaths resulted mainly from heart problems in older patients and could have been a late side effect from the radiation treatment. Because of these analyses, radiation therapy was not typically recommended for women with stage II or III breast cancer treated with mastectomy.

Standard radiation therapy following a lumpectomy consists of a limited dose of radiation (50 Gy) to the entire affected breast. While this treatment leads to long-term outcomes similar to those from mastectomy, women under age 50 experience higher rates of local recurrences following this treatment regimen compared to their elder counterparts. Researchers have theorized that an additional boost of radiation aimed only at the area from which the cancer was removed would reduce the rates of local recurrences, especially in younger patients.

The European Organization for Research and Treatment of Cancer conducted a clinical trial evaluating 5,318 women diagnosed with stage I or II breast cancer who had undergone a lumpectomy followed by the standard dose of radiation. Approximately half of the patients were given an additional small dose of radiation (16 Gy) to the area where the cancer had been located, while the other half received no additional treatment. Data indicated that the additional dose of radiation to the site of the removed cancer reduced the overall rate of a local recurrence by nearly 50%. Women 40 years old and younger exhibited the largest benefit, with local recurrences occurring in only 10.2% of patients receiving additional radiation, compared to 19.5% of those receiving standard treatment. Overall survival rates and the development of distant metastases were similar whether women received an additional boost of radiation or standard therapy. Side effects including cosmetic results and fibrosis (formation of scar tissue) were not affected by the additional radiation.

In late 1997, the results of two clinical studies evaluating treatment with mastectomy followed by chemotherapy with or without radiation in premenopausal women with stage II-III breast cancer were reported in the New England Journal of Medicine. In both studies, women treated with radiation following mastectomy and chemotherapy lived longer and were less likely to develop a recurrence of cancer. Radiation therapy decreased the risk of dying from cancer by approximately 33%. The probability of surviving 10 years from treatment was increased from 54% to 64% and 45% to 54% in the two studies, respectively. No significant long-term side effects of radiation therapy were reported. Current evidence increasingly supports the use of radiation following surgery and chemotherapy in women with stage II or III breast cancer. Certain groups of women known to be at high risk of local breast cancer recurrence should strongly consider radiation therapy. These include:

* Cancer greater than 5 centimeters in greatest dimension
* 4 or more involved axillary lymph nodes
* Cancer involving the margin of resection

What is the Optimal Sequence of Radiation in Stage I-III Breast Cancer?

The timing or sequence of radiation therapy may be important. A large clinical study has addressed the question of whether radiation therapy should be given before or after chemotherapy following breast-conserving surgery. Following breast-conserving surgery, half the patients were treated with chemotherapy followed by radiation and half were treated with radiation followed by chemotherapy. The patients treated with chemotherapy followed by radiation were more likely to be alive 5 years from treatment than patients treated with radiation followed by chemotherapy. Patients treated with chemotherapy survived longer because they were less likely to experience systemic (metastatic) recurrence of their cancer. Patients treated with radiation first, however, were less likely to experience a local recurrence of their cancer.

It is much easier to treat local recurrence of cancer than systemic recurrence of cancer and this may explain why patients treated with chemotherapy followed by radiation had improved survival compared to patients treated with radiation followed by chemotherapy. An additional explanation is that delivering radiation therapy before chemotherapy treatment of systemic disease may adversely affect the doctor's ability to deliver the chemotherapy treatment. Although the sequence of treatments is undergoing continued evaluation, the current data suggest that standard treatment of breast cancer outside the context of a clinical study should include definitive surgery first, followed by systemic chemotherapy and lastly, radiation. Hormone therapy can begin during or following radiation therapy. One notable exception to this sequence is patients with locally advanced breast cancer. In these patients, administration of chemotherapy prior to surgery (neoadjuvant) may allow for greater breast conversation.
Stage IV or Recurrent Breast Cancer

Radiation therapy also plays an important role in women with stage IV or recurrent breast cancer. Chemotherapy and hormonal treatment are the mainstay for women who have stage IV breast cancer at the time of diagnosis. Local control of breast cancer eradication has less impact on a patient's outcome because the major cause of treatment failure is systemic cancer recurrence. Therefore, radiation therapy to the involved breast has not typically been recommended for women receiving systemic chemo-hormonal therapy for metastatic breast cancer.

More recent aggressive chemotherapy treatment of stage IV breast cancer has been reported to produce long-term survival without cancer recurrence in 15-20% of women. Since these women are not experiencing a systemic cancer recurrence, prevention of cancer recurrence in the breast or lymph nodes is of greater importance. The results of a clinical study in which women with stage IV breast cancer achieving a complete remission to chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant and local radiation to the breast was recently reported and raises the question of whether radiation may be beneficial in women with stage IV breast cancer in complete remission.

In this study, the patients in complete remission treated with radiation therapy had a lower relapse rate and were more likely to be alive without evidence of cancer recurrence than women not treated with radiation therapy. The chance of relapse was 36% in patients not treated with radiation, compared to 19% in patients treated with radiation. Thirty-one percent of patients treated with radiation were alive without evidence of cancer recurrence at 4 years following treatment, compared to 21% of patients who were not treated with radiation. Patients treated with radiation were also more likely to live longer, with 30% alive 4 years following treatment, compared to only 16% of patients not treated with radiation.

While this clinical study was not designed to evaluate the role of radiation therapy in patients achieving a complete remission to chemotherapy, consolidative treatment with radiation therapy after chemotherapy-induced clinical remissions in women with stage IV breast cancer appears to reduce the risk of cancer recurrence and may improve a patient's chance of overall survival. Future clinical studies will need to be designed to evaluate the role of radiation in patients with stage IV breast cancer in a more formal manner.
Radiation for Palliation

Radiation therapy also plays an important role in providing symptomatic relief from advanced breast cancer. Patients developing metastatic cancer to the bone, skin, selected lymph nodes, and other sites can achieve a complete remission when treated with radiation to the site of cancer recurrence. Radiation can relieve symptoms from cancer and prevent fractures of bones when used early.

Copyright Breast Cancer Information Center on CancerConsultants.com

mdb, 

I don't mean this to be judgement of your tx decision.  It is just a simple observation.

If you had been more aware of your surroundings or if your daughter had wiped up the water, you wouldn't have fallen in the first place. 

From one walker to another, I do hope you recover quickly.  

I chose mammosite and was focused  on destroying any cancer cells that may have been disturbed during the needle biopsy and brought out of the area. 

I've read some of these posts and find them very disturbing. I'm not sure where I fit in here except that I had one positive sentinode for stage 2a with lumpectomy wide margins then chemo and rads in 2006 age 49.  My IDC tumor was removed from my left breast 10 oclock position so inside quadrant. I was strongly talked out of mastectomy as too aggressive a treatment for me and I had to insist on oopherectomy for my very strong receptor positive tumor (100%).

I have a strong family hx of heart dx.  Last year my pulmonary specialist ordered an echo cardiogram on my heart - findings were heart murmur, calcified aortic valve, mild mitral valve regurgitation, mild tricuspid regurgitation, mild redundancy  of anterior lefalet of miltral valve without sign of prolapse. 

I saw my radiation oncologist last month and told him this information.  He told me these heart issues must have been present prior to my treatments and he would not discuss how the radiation treatments might affect me in the future.  He suggested I join a support group as I was obviously upset or I could go back to my surgeon now and request the mastectomy (sounds like pass the patient to me).  I'm wondering if I should be monitored by a cardiologist as I can not undo how I was treated in the past but need to take care of my self for the future.  IMO many doctors use fear as a mechanism to get patients to pursue these treatments.  Then if the cancer recurs it is the fault of the patient for not initially listening to the doctor.  Yes, I also do not trust these medical experts and only feel comfortable with my pulmonary specialist and PCP.

mdb, I strongly disagree with your assertion that EVERY woman is treated exactly the same regardless of diagnosis (DCIS or Stage IV).  That is simply not true.  I'm not saying that there aren't centers or clinics that a blanket standard of care may exist, but any center concerned with their reputation and quality of care offers several options for treatment.  It is definitely not one size fits all and this is where women must begin to question there doctors if this is how they are approached.  I've not heard of someone being recommended by a physician to have a mastectomy for DCIS.  In fact, surgeons in general seem to be reluctant to do a mastectomy unless there is a clear indication for it.  But I have read posts from women that have DECIDED on their own to have a mastectomy.  Standard of care for mastectomy patients is that radiation is only indicated in circumstances where recurrence is high such as a later stage. In fact, one poster had a double mastectomy for a unilateral DCIS diagnosis and had difficulty finding a surgeon to perform it. 

It is great that you are so comfortable with your treatment decision as should every woman no matter what their decision is.  But I do think it is irresponsible to express your opinion as an absolute assumption that EVERY woman is overtreated.  This can have a profound effect on a woman who is clearly in need of this treatment but is petrified by a blanket statement such as that.  Your comfort level with recurrence stats IS NOT the experience of every woman.  I wanted my best shot of kicking cancer's butt at the beginning in hopes of never having to have treatment again.  The benefits far outweighed the risks. 

Cp418, I had treatment to my left side and had to way the risk of possible treatment side effects on my heart.  At 38, I plan to be here for many years to come and this could be an issue down the road.  Unfortunately, radiation damage can not be distinguished from any other form of damage that is caused by other factors.   But I was comfortable with the incidence statistics comparing heart disease between the general population and cancer patients.  I'm actually more concerned about the chemotherapy long term effects as opposed to radiation.

Larousse, it is indeed part of the rationale for radiation to irradicate any cancer cells that would be undetected by modern equipment.  A small area of DCIS in a breast does not negate the possibility for undected cells to be lurking elsewhere.  It really is all in each woman's comfort level of knowing that possibility and the likelihood of whether or not it would cause a recurrence.

I have heard from 3 separate oncologists, after a huge study in the Netherlands, that the "seeding" issue is not true.  In part of the test, they actually injected live cancer cells in mice, and the cells died.  Many things have to be just right for cancer to grow, and I guess this set of circumstances is not always present. 

In any case, that "seeding" theory has been pretty well de-bunked, sounds logical, but cancer is not that simple.

Hugs, Shirlann