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Radiation and Possible Benefits of RNI

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Forum Name: Let's Talk About Radiation Therapy
Forum Description: A place to discuss Radiation Therapy
URL: http://forum.tnbcfoundation.org/forum_posts.asp?TID=10437
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Topic: Radiation and Possible Benefits of RNI
Posted By: 123Donna
Subject: Radiation and Possible Benefits of RNI
Date Posted: Oct 30 2012 at 8:20pm
I wanted to post this thread under the radiation therapy section.  It was getting lost under the talk section and has some good data for our members.

http://forum.tnbcfoundation.org/radiation-rni_topic8602_page1.html - http://forum.tnbcfoundation.org/radiation-rni_topic8602_page1.html

http://chicago2011.asco.org/ASCODailyNews/triplenegative.aspx - http://chicago2011.asco.org/ASCODailyNews/triplenegative.aspx


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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15




Replies:
Posted By: 123Donna
Date Posted: Nov 04 2012 at 7:06pm

Triple-Negative Breast Cancer Associated With Higher Risk of Local Recurrence

ScienceDaily (Oct. 31, 2012) — Research from The Cancer Institute of New Jersey (CINJ) shows that women with triple-negative breast cancer and no more than three positive lymph nodes following a mastectomy have a higher risk of local recurrence than similar women whose disease is not classified as triple-negative. The work will be presented as an abstract during the 54th Annual Scientific Meeting of the American Society for Radiation Oncology (ASTRO) in Boston this week. The Cancer Institute of New Jersey is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (RWJMS)


To read the entire article:

http://www.sciencedaily.com/releases/2012/10/121031141721.htm - http://www.sciencedaily.com/releases/2012/10/121031141721.htm


Summary:

"By further defining the risk of local recurrence in women with triple negative breast cancer, clinicians can better determine whether radiation treatment should be part of post-mastectomy therapy," noted the lead author of the research, Atif J. Khan, MD, a radiation oncologist at The Cancer Institute of New Jersey and an assistant professor of radiation oncology at RWJMS.



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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: 123Donna
Date Posted: Apr 17 2013 at 8:30am
http://www.ncbi.nlm.nih.gov/pubmed/23576181#" rel="nofollow - Cancer.  2013 Apr 10. doi: 10.1002/cncr.28085. [Epub ahead of print]

Analysis in early stage triple-negative breast cancer treated with mastectomy without adjuvant radiotherapy: Patterns of failure and prognostic factors.

http://www.ncbi.nlm.nih.gov/pubmed?term=Chen%20X%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Chen X ,  http://www.ncbi.nlm.nih.gov/pubmed?term=Yu%20X%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Yu X ,  http://www.ncbi.nlm.nih.gov/pubmed?term=Chen%20J%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Chen J ,  http://www.ncbi.nlm.nih.gov/pubmed?term=Zhang%20Z%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Zhang Z ,  http://www.ncbi.nlm.nih.gov/pubmed?term=Tuan%20J%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Tuan J ,  http://www.ncbi.nlm.nih.gov/pubmed?term=Shao%20Z%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Shao Z ,  http://www.ncbi.nlm.nih.gov/pubmed?term=Guo%20X%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Guo X ,  http://www.ncbi.nlm.nih.gov/pubmed?term=Feng%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=23576181" rel="nofollow - Feng Y .

Source

Department of Radiation Oncology, Hospital of Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

Abstract

BACKGROUND:

The objective of this study was to evaluate and identify patterns of failure and prognostic factors for locoregional recurrence (LRR) that could justify postmastectomy radiotherapy after modified radical mastectomy in patients with early stage triple-negative breast cancer.

METHODS:

Between January 2000 and July 2007, the authors retrospectively analyzed 390 patients who had triple-negative breast cancer with T1/T2 tumors and from zero to 3 positive lymph nodes (pathologic T1-T2N0-N1) who underwent modified radical mastectomy without postmastectomy radiotherapy at the author's institution. The 5-year cumulative incidence for events was calculated using Kaplan-Meier analysis, and subgroups were compared using the log-rank test. Multivariate analysis was performed using a Cox proportional hazards model.

RESULTS:

Overall, 86.4% of patients received chemotherapy. At a median follow-up of 60.5 months, the 5-year cumulative rates of local recurrence, regional recurrence, LRR, and distant metastasis were 5.4%, 4.7%, 8%, and 13.4%, respectively. On multivariate analysis, age <50 years, the presence of lymphovascular invasion, grade 3 tumor, and 3 involved lymph nodes were associated significantly with an increased risk of LRR. The 5-year LRR rate for patients who had 0 or 1 risk factor, 2 risk factors, and 3 or 4 risk factors was 4.2%, 25.2%, and 81% (P < .0001), respectively. The presence of lymphovascular invasion and having 3 involved lymph nodes were statistically significant predictors of regional recurrence, and the patients who had regional recurrence had a significantly greater risk of distant metastases compared with patients who had local recurrence (59.1% vs 20.9%; P  <  .0001).

CONCLUSIONS:

Several risk factors were identified in this study that correlated independently with a greater incidence of LRR in patients who had early stage triple-negative breast cancer. The current results indicated that postmastectomy radiotherapy should be considered for those patients who have 2 or more of these factors. Cancer 2013;000:000-000. © 2013 American Cancer Society.

Copyright © 2013 American Cancer Society.

PMID:
 
23576181
 
[PubMed - as supplied by publisher]


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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: 123Donna
Date Posted: Oct 03 2013 at 1:52pm
I started another thread under the radiation forum, but wanted to put the link here also.

Improved survival in breast cancer through early treatment of chest lymph nodes

Giving radiation therapy to the lymph nodes located behind the breast bone and above the collar bone to patients with early  http://www.medicalnewstoday.com/articles/37136.php" rel="nofollow - breast cancer  improves overall survival without increasing side effects. This new finding ends the uncertainty about whether the beneficial effect of radiation therapy in such patients was simply the result of irradiation of the breast area, or whether it treated http://www.medicalnewstoday.com/info/cancer-oncology/" rel="nofollow - cancer  cells in the local lymph nodes as well, the 2013 European Cancer Congress (ECC2013) [1] heard.

Dr Philip Poortmans, a radiation oncologist from the Institute Verbeeten, Tilburg, The Netherlands, and a member of the EORTC Radiation Oncology and Breast Cancer Groups, said that results from the international randomised trial, which involved 4004 patients from 43 centres, were convincing. "Our results make it clear that irradiating these lymph nodes give a better patient outcome than giving radiation therapy to the breast/thoracic wall alone. Not only have we shown that such treatment has a beneficial effect on locoregional disease control, but it also improves distant metastasis-free survival and overall survival," he told an ECC2013 news briefing on Friday.

Lymphatic drainage from breast cancer means that the cancer is more likely to spread to other parts of the body. It normally follows two pathways. The best known is to the axilla (armpit), and these lymph nodes are usually treated by surgery and/or radiation therapy. The second pathway drains to the internal mammary (IM) lymph nodes behind the breast bone, and also to those just above the collar bone, the medial supraclavicular (MS) nodes. Because of uncertainty about the effects of treatment in this area, and particularly concerns about the increased toxicity that might be due to the irradiation of a larger area, many centres do not currently treat the IM-MS lymph nodes.

To read the entire article:

http://www.medicalnewstoday.com/releases/266763.php" rel="nofollow - http://www.medicalnewstoday.com/releases/266763.php



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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: 123Donna
Date Posted: Jul 08 2014 at 6:03pm
Bumping for JMJ

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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: 123Donna
Date Posted: Jul 23 2015 at 8:45pm
Additional radiation reduces breast-cancer recurrence for some patients: Hamilton study

A study has found no increase in overall survival but a reduction in  http://www.medicalnewstoday.com/articles/37136.php" rel="nofollow - breast cancer  recurrence when additional radiation is given to the lymph nodes as well as the standard treatment of whole-breast irradiation after breast-conserving surgery.

The research, which examined the addition of regional nodal irradiation to whole-breast irradiation compared with whole-breast irradiation alone, was published today in the prestigious New England Journal of Medicine. It was led by Dr. Tim Whelan, professor of oncology with McMaster University's Michael G. DeGroote School of Medicine and a radiation oncologist at Hamilton Health Sciences Juravinski Cancer Centre.

The study involved women with axillary node-positive ( http://www.medicalnewstoday.com/info/cancer-oncology/" rel="nofollow - cancer  in the lymph glands under the arm) or high-risk node-negative breast cancer (no cancer in under arm nodes, but cancer with bad prognostic features).

Radiotherapy to the chest wall and regional lymph nodes (under the arm, above the collar bone and under the breast bone), known as regional nodal irradiation, is used after mastectomy in women with node-positive breast cancer who are treated with adjuvant systemic therapy. Such treatment reduces breast cancer recurrence and improves survival.

Currently, most women with breast cancer are treated with breast-conserving surgery followed by radiation to the whole breast. An important unanswered question was whether the addition of regional nodal irradiation to the usual radiation of the breast would improve outcomes.

"This study is important because it shows that additional radiation to the surrounding lymph nodes provides added benefit to women, particularly those with involvement of the lymph nodes in the axilla," said Whelan.

"Additional radiation to the surrounding lymph nodes reduced the risk of subsequent recurrence of breast cancer both locally, such as under the arm, and at sites distant from the breast, such as the bone, liver and lung. The treatment did not increase survival, but follow-up is still relatively early."

The nodal treatment was associated with limited toxicity, including a slight increase in the risk of radiation pneumonitis and lymphedema ( http://www.medicalnewstoday.com/articles/187978.php" rel="nofollow - fluid retention  and swelling) of the arm.

The study, conducted over 14 years by the NCIC Clinical Trials Group at Queen's University in Kingston, Ont., involved more than 1,800 patients and a team of investigators from Canada, the Unites States and Australia.

"Further research is necessary to determine which women are most likely to benefit and who may avoid the additional radiation," said Whelan, adding that it is exciting that another study performed in Europe has showed very similar findings.

http://www.medicalnewstoday.com/releases/297186.php?tw" rel="nofollow - http://www.medicalnewstoday.com/releases/297186.php?tw



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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: LymphActivist
Date Posted: Aug 20 2015 at 2:33am
It always dismays me when the summaries of scientific studies are shaded to support the biases of the writer and are not supported by the facts of the study. In the summary above we learn that "The treatment did not increase survival, but follow-up is still relatively early." and that "The nodal treatment was associated with limited toxicity, including a slight increase in the risk of radiation pneumonitis and lymphedema ( http://www.medicalnewstoday.com/articles/187978.php" rel="nofollow - fluid retention  and swelling) of the arm." 
Not mentioned is the increase in the rate of lifelong breast and truncal lymphedema (in addition to upper limb lymphedema) and cardiac damage due to the radiation. Is this a reasonable cost for no increase in survival?

I refer the interested reader to my web site for further information at http://www.lymphactivist.org/breast_lymphedema-1.pdf


Posted By: Kellyless
Date Posted: Aug 20 2015 at 9:43am
My 2.2 cm tnbc tumor was "off the charts aggressive" according to the pathologist that did my second opinion re-analysis of tumor and removed lymph nodes (one node was cancerous). I had the additional axilla, collar bone and chest wall node location radiation. I'm 6 years NED with no complications from radiation including no lymphedema. ((Shrug)) personal choice of course, but obviously I have no regrets.

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IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/16 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!


Posted By: rosewater
Date Posted: Aug 20 2015 at 1:39pm
The article also states: "Additional radiation to the surrounding lymph nodes reduced the risk of subsequent recurrence of breast cancer both locally, such as under the arm, and at sites distant from the breast, such as the bone, liver and lung."

I do not have any regrets doing my radiation. The fact that it reduces a recurrence as well as distant metastasis is huge for me. If I have a recurrence, I will know that I've done everything possible to try to prevent it. I will not have any feelings of Oh, if only I had done so and so. My oncologists took my case to committee, and even though I did not have nodal involvement, 5 out of 7 of the oncologists strongly recommended I have the radiation including the axilla, collar bone and chest wall node location. As Kellyless states above, it's a personal decision. I'm happy with mine.

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DX IDC TNBC 03/14 age 40, Stage 1, Grade 3, 2cm, 0/4Nodes, lumpectomy 04/14, DD A/C x4, Taxol x12, Carboplatin x2, BMX 10/14, rads x28 Finished Jan 14/15, Oopherectomy Jan 29/15 BRCA 2+


Posted By: mindy555
Date Posted: Dec 09 2015 at 1:53pm
I feel badly in a way that I didn't have rads.  At the time it was presented as only helping L/R recurrence and I had 3 opinions opposed due to the risk benefit factors.  I was node negative,  stage II NO, BRCA 1+, no lymphovascular invasion,  achieved a pCR but also have a strong family history of leukemias.  I can't help but think of the scenario with Robin Roberts from GMA, which made me feel that it may cause later disease in my case. 

My 1st consult with an RO at MD Anderson was most convincing that rads wouldn't be necessary.  Yet I went on to find that my next 2 doctors agreed. 

I'll be 4 years out in February, feel great.. but don't trust this nasty aggressive and sneaky-ass disease.  I honestly feel if I had it to do over again, knowing what I know now, I would have insisted on rads.  Disapprove


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Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012


Posted By: gordon15
Date Posted: Dec 22 2015 at 9:01am
y wife had a 2nd opinion re/ how much radiation when she finishes Taxol chemo. They referred her to a 2nd opin within the Scripps system but she got approval for one @ Moores Cancer Center/UCSD. He concurred with Scripps =radiation of entire area, armpit & clavicle lymph nodes, port has to come out. Said will review her file to decide on sternum nodes. He said they are mostly concerned with incision from surgery. Thanks for imput on this topic,


Posted By: mindy555
Date Posted: Jan 04 2016 at 1:48pm
Wonderful, helpful information Donna.  I know for some questionable cases, this is one of the hardest decisions we must make.   It was for me.  The newer studies certainly point to rads with ANY positive nodes.  My question would be, how do they really know with neoadjuvant therapy that you didn't start out with positive nodes and throughout the process of chemo, the cancerous cells were killed- However, some active cells got sneaky and are waiting to rear their ugly head.

It was a tough decision almost 4 years ago.. and it still creeps in my mind.  Being one who was also metaplastic did offer some reassurance, as the majority of women with metaplasia are node negative in a adjuvant setting.

I hope this makes sense and helps someone else who is faced with making that "fine line" decision.  I'm such a skeptic by nature, so I question everything and drive myself crazy doing so.  Finally I'm past that stage but take nothing for granted.  Instead I try to live in the moment.  

That's where individual spirituality and grateful exercises (mediation and such) with full-on cognizant gratefulness comes into play and makes my life so joyful.  I highly recommend truly relishing in the day, one day at a time. Hug 


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Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012


Posted By: Kellyless
Date Posted: Jan 08 2016 at 12:36am
No regrets here, for taking the radiation!  Besides not having a recurrence for this long, the armpit hair never grew back on the radiated side :)  It's the little benefits sometimes, you have focus on whatever lil positive you can find going thru this ;)


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IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/16 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!


Posted By: mindy555
Date Posted: Apr 28 2016 at 4:35am
Congrats on 6 years at the time of your post, Kellyless.  Since you had a lumpectomy rads are a given.  I'm going on 5 years after a bilateral mastectomy which makes the decision a little tougher, but I'm doing fine.  It's pretty remarkable to have a pCR with metaplastic TNBC- 10% is the lower stat for this more aggressive form of Triple Neg.

I feel truly blessed today.


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Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012


Posted By: 123Donna
Date Posted: Jun 08 2016 at 8:05am
Post-Mastectomy Locoregional Recommendations

The guideline contains an update on recommendations for post-mastectomy radiation (PMRT). For patients with four or more positive lymph nodes, whole breast irradiation with or without a boost to the tumor bed is recommended following lumpectomy; radiation to the chest wall following comprehensive nodal radiation is recommended following mastectomy (category 1 recommendations).


For patients with one to three positive lymph nodes in either setting, following lumpectomy, the recommendation is for treatment to the whole breast with or without a boost, and to strongly consider regional nodal radiation. Similarly, for women following mastectomy, the guideline language is to strongly consider regional nodal radiation.


http://www.medpagetoday.com/reading-room/asco/breast-cancer/58369?xid=nl_mpt_DHE_2016-06-08&eun=g456405d0r" rel="nofollow - http://www.medpagetoday.com/reading-room/asco/breast-cancer/58369?xid=nl_mpt_DHE_2016-06-08&eun=g456405d0r



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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: Jacklin
Date Posted: Jun 08 2016 at 10:57am
Donna, thank you for diligently posting all these articles for us. They've been very timely for me this week. I so appreciate you doing this, thank you.

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Dx: Nov. 27/15, TNBC, left breast & lymph, BRCA -; Chemo: Dec 4/15 - Mar 4/16; 4 DD A/C, 3 DD Taxol; BMX/ALND: April 26/16; Stage 3C; Radiation: June 10-July 15/16; 1 cycle Xeloda: Aug 15 - 28/16


Posted By: 123Donna
Date Posted: Jun 08 2016 at 7:48pm
Jacklin,

You are so welcome.  


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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: 123Donna
Date Posted: Oct 11 2016 at 11:05pm

New guidelines on radiation therapy for breast cancer

New guidelines issued by three leading  http://www.cbsnews.com/feature/stories-of-survivors/" rel="nofollow - cancer  organizations suggest that more  http://www.cbsnews.com/news/two-genes-might-help-predict-breast-cancer-survival/" rel="nofollow - breast cancer  patients should consider radiation therapy after a mastectomy.

Overall, the guidelines say there’s enough evidence to show radiation  http://www.cbsnews.com/news/the-debate-over-early-breast-cancer-treatment/" rel="nofollow - treatment  after a mastectomy decreases the risk of breast cancer recurrence, and that even women with smaller tumors and three or fewer lymph nodes involved can benefit from the therapy.

“The new guidelines say there is clear evidence that the benefit of [post-mastectomy radiation therapy] extends to women with limited lymph node involvement,” said Dr. Stephen Edge. He is vice president for health care outcomes and policy at Roswell Park Cancer Institute in Buffalo, N.Y. Edge was co-chair of the panel that developed the new guidelines.

One radiation treatment expert welcomed the updated recommendations.

“The guideline is timely,” said Dr. Janna Andrews, an attending physician in radiation medicine at Norwell Health Cancer Institute, in Lake Success, N.Y. “The field of post-mastectomy radiation is changing. It’s always up for discussion now as to who needs [post-mastectomy radiation therapy].”

The new guidelines help clarify what used to be a gray area, Andrews explained. “In the past, if a woman had a small tumor, less than 5 centimeters, and not more than three or four positive lymph nodes, many doctors would say she does not need [post-mastectomy radiation therapy],” she said.

The guidelines don’t offer a single formula for which patients need radiation therapy, Edge noted. But they do focus on the group of women for whom there is the most debate about the value of radiation.

“There is a great deal of controversy about whether women with one, two or three lymph nodes [with cancer] have sufficient risk to warrant radiation,” he said. “For women with four or more lymph nodes involved, everyone would recommend radiation.”

The guidelines also strongly support input from all specialists who treat  http://www.cbsnews.com/news/shannen-doherty-shaves-head-amid-breast-cancer-battle/" rel="nofollow - breast cancer  in making the decision about radiation treatment. That typically includes the surgeon, radiation physician and an oncologist.

Doctors need to weigh the risks and benefits, Edge added.  http://www.cbsnews.com/news/chemo-brain-not-linked-to-breast-cancer-drug/" rel="nofollow - Side effects  can include redness of the skin, swelling and skin breakdown severe enough to compromise future breast reconstruction, he explained.

Edge said that doctors need to consider patients individually. For instance, he explained, ‘’a woman 65 who has microscopic involvement in a single lymph node and an estrogen-receptor positive cancer would be very different from a 38-year-old who has three lymph nodes involved and so-called triple-negative breast cancer.” The younger woman, he said, would typically be advised to get radiation.

The older woman, because her risk is lower, should have a discussion with her doctor to decide if the benefit outweighs the risk, Edge noted.

Andrews said that one take-home message for patients is to expect the surgeon to have consulted with the radiation oncologist and others on her team. If a woman’s doctor tells her she does not need radiation after a mastectomy, the woman should be told why and she should ask if the radiation oncologist weighed in on the decision.

Edge was a panel representative from the American Society of Clinical Oncology, which created the guidelines along with the American Society for Radiation Oncology and the Society of Surgical Oncology.

All three groups published the guidelines online this week in their respective journals: the Journal of Clinical OncologyPractical Radiation Oncology and the Annals of Surgical Oncology.
http://www.cbsnews.com/news/breast-cancer-patients-radiation-therapy-guidelines/" rel="nofollow - http://www.cbsnews.com/news/breast-cancer-patients-radiation-therapy-guidelines/



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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15



Posted By: mindy555
Date Posted: Jul 20 2017 at 11:10am
Today I'm at total peace with my decision to skip rads.  I had 2 extra infusions of FEC. In a sense I feel I was "over treated" as it is. Since my lump was palpable I could feel it melting away after the 1st FEC treatment after Taxol failed. The docs at MDACC were convinced I was node negative at the onset.

I had a left and right sentinel node dissection at time of bilateral mastectomy which were negative.  My frame of mind during tx was to throw everything at it as possible.  At some point you have to believe the risk/benefits from the best of the best radiology oncologists and move on.  The long term SE from chemo are enough for me, although I doubt radiation would have exacerbated those being very different. Had I had a positive node of course I'd feel differently.  As my doctors said "there's nothing to radiate."  I'm at total peace with the decision now, over 6 years out from dx.

Someone mentioned a SE of no underarm hair after rads.  I can't say that radiation attributed to that because I no longer have under arm hair either.  I had very light body hair to begin with and now am basically hairless everywhere except my head (which is so plentiful it makes up for being 'body bald')  Wink

Big hugs for Donna.  Hug


-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012


Posted By: 123Donna
Date Posted: Jun 11 2018 at 6:54pm

Fifteen-year results of the randomised EORTC trial 22922/10925 investigating internal mammary and medial supraclavicular (IM-MS) lymph node irradiation in stage I-III breast cancer.

Applying  https://breastcancer-news.com/radiation-therapy/" rel="nofollow - radiation therapy  to lymph nodes behind the breast bone and above the collar bone can improve outcomes for earlier-stage  https://breastcancer-news.com/breast-cancer-overview/" rel="nofollow - breast cancer  patients, with limited side effects, Phase 3 long-term data show.

Data found that 15 years after such treatment, 73.2 percent of patients given this more extensive radiation were alive, compared to 70.8 percent of those who underwent standard of care.

Women with breast cancer are at risk of having their disease spread to the lymph nodes, and from there elsewhere in the body. While lymph nodes in the axilla (armpit) are the most commonly affected, and are usually treated with  https://breastcancer-news.com/breast-cancer-surgery/" rel="nofollow - surgery  or radiation, the cancer may spread into lymph nodes behind the breast bone — called internal mammary (IM) lymph nodes – and then to those above the collar bone – called medial supraclavicular (MS) lymph nodes.

While IM-MS nodes can be treated with  https://breastcancer-news.com/radiation-therapy/" rel="nofollow - radiation therapy , concerns about the side effects of increasing the radiation area to the chest has limited such use.

In an attempt to settle this question, investigators designed a clinical trial that assessed the long-term outcomes in women receiving radiation to their IM-MS lymph nodes compared to a control group that did not.

The trial ( https://clinicaltrials.gov/ct2/show/NCT00002851" rel="nofollow - NCT00002851 ), carried out by the  http://www.eortc.org/" rel="nofollow - European Organisation for the Research and Treatment of Cancer (EORTC) , involved 4,004 women at 43 centers diagnosed with stage 1 through 3 breast cancer, who had undergone surgery to remove their breast tumor and nearby (axillary) lymph nodes.

Patients were divided in two groups: those who received 25 irradiation sessions over five weeks, and those who did not undergo further treatment.

After a median follow-up of 15.7 years, 1,117 patients had died. But researchers found that fewer patients in the radiation group had died from breast cancer compared to the control group — 15.8% vs. 19.7%. Similarly, the chance of cancer re-appearance was lower in patients who had received radiation treatment – 24.5% vs. 27.1%.

Overall survival was also higher in the group given this radiation treatment (73.2%) compared to control patients (70.8%).

“Our results make it clear that irradiating these lymph nodes gives a better patient outcome than giving  https://breastcancer-news.com/radiation-therapy/" rel="nofollow - radiation therapy  to the breast/thoracic wall alone. Not only have we shown that such treatment has a beneficial effect on disease control, but it also improves breast-cancer related survival,” Philip Poortmans, head of the department of radiation oncology at the Institut Curie in Paris, said in a  https://www.eurekalert.org/pub_releases/2018-06/eofr-icl060118.php" rel="nofollow - press release .

This 15-year follow-up is the second of three scheduled analyses planned for this Phase 3 clinical trial, with the last evaluation set for 20 years post-treatment. “We want to look further at which patients are most likely to benefit from this treatment, and to identify the best techniques for doing it efficiently and safely,” Poortmans said.

According to the researchers, side effects of IM-MS radiation treatment were largely minor and temporary, and included “no evidence … in the incidence of second malignancies, contralateral breast cancer, or cardiovascular deaths.”

“It is very important that we record all possible events, including recurrence and toxicity, and an even longer follow-up will also give us the opportunity to continue evaluating our patients in other areas, for example quality of life and wellbeing,” Poortmans said.

“Advances in radiation therapy techniques and new therapies, and earlier diagnosis may increase the benefit from IM-MS radiation treatment,” he concluded. “But we believe that our trial has already given solid evidence of the benefits of radiation treatment of the IM-MS lymph nodes.”

http://breastcancer-news.com/2018/06/04/chest-lymph-node-radiation-therapy-improves-breast-cancer-patient-outcomes-long-term-study-reports" rel="nofollow - http://breastcancer-news.com/2018/06/04/chest-lymph-node-radiation-therapy-improves-breast-cancer-patient-outcomes-long-term-study-reports

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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15




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