Hi Brocha,
I'm sorry that I missed your post and questions. I'm not a medical professional so can only share from my experience. It's hard to navigate the cancer world and all the options/choices. You are asking all good questions. Here's my thoughts to your questions:
1) The rad-oncs that I've spoken to said that radiation can get to
places -- e.g. chest wall -- where mastectomy can't reach. (Surgeon
vehemently denied this!) Does that put radiation at some advantage,
therefore, in my case--since the lumpectomy was posterior and close to
the chest wall?
A: I believe this could be true, especially if the tumor was close to your chest wall or the margins weren't good. I guess it depends on how close to the chest wall and what type of margins did the surgeon get?
2) I asked the rad-onc at Sloan whether TNBC is
particularly radiosensitive (I got that feeling after reading some
studies on this forum), and whether that would be a point in favor of
radiation. She said she wasn't so sure about whether that was the case.
A: I'm not sure TNBC is any more sensitive to radiation than other bc's.
3)
One (famous) rad-onc went as far as to say that she prefers radiation
because she is concerned about the assault on the immune system after a
trauma like mastectomy and its effect on the body's ability to fight on a
systemic level. (I'd never heard anything like that before or since).
A: I never heard this. Sure a mastectomy is a major surgery compared to lumpectomy, but I don't know about the assault on the immune system. I always felt that the different specialties were slanted toward their treatments, eg. surgeons recommend surgery, oncs recommend chemo as primary tool, rad oncs recommend radiation to treat.
5) I had pericarditis during part
of chemo (which the cardiologist thought probably came from a virus,
since I'd had a chest rash and low fever shortly before it was
diagnosed) -- how concerned should I be about this when considering
radiation?
A: I'd ask your cardiologist if you are at increased risk with radiation treatment.
6) It was only on this forum that I read about
proton therapy, IM radiation, axilla radiation--no doctor ever discussed
them with me. Are they ever used in T1bn0 TNBC situations?
A: I'm not sure about the other types of radiation being used on your stage, but if you are concerned about surrounding tissue damage with it being close to the chest wall and lungs, then ask about IMRT or Proton radiation. Sometimes it's an insurance issue where they won't pay for the more specialized radiation treatments. I had IMRT radiation because of the location of the recurrence to the internal mammary nodes under my sternum. My treatment center at the time was one of the few that had the newer technology and luckily my insurance covered it.
7)
I'm also confused about the different time frames for radiation---one RO
prescribed 6 weeks, one 4 weeks (described as a kind of "dose-sense"
radiation used in England and Canada) and one 3 weeks! Is there a
preferred course for TNBC?
A: I know they want your body to recover from chemo and get your immune system stronger before starting radiation. I've read that radiation usually starts 3 - 4 weeks after finishing chemo.
8) I would have thought that with all
the irregularities in the breast tissue that was sampled, mastectomy
would have been recommended--but I haven't found this to be the case.
The docs just say "it's your choice...survival is the same either way."
Do those of you who have been paying attention to this issue for many
years as TNBC patient supporters have a leaning either way?
A: It sounds like you had lobular too and atypical ductal hyperplasia (ADH) in the other breast? "Atypical ductal hyperplasia (ADH) is not a form of breast cancer. Rather, it is a marker for women who may have a risk factor for developing breast cancer in the future." I had a bilateral mastectomy and the surgical path report on the "good" breast came back with ADH too. When I asked my surgeon after surgery if that meant I would have gotten bc in the other breast, she just said you don't need to worry about that now.