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Radiation following mastectomy w/ no positive node

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Topic: Radiation following mastectomy w/ no positive node
Posted By: beejack209
Subject: Radiation following mastectomy w/ no positive node
Date Posted: May 09 2019 at 12:58pm
Iím just curious who all has had radiation following a mastectomy with no positive lymph nodes. I was told I had LVI present on my path results following surgery. My oncologist said the radiologist didnít think I needed radiation because the LVI ďis goneĒ. Apparently it was taken out during the surgery. This whole thing makes me nervous because if there is a chance that radiation would be beneficial, I want to give it all weíve got.



Replies:
Posted By: cheeks
Date Posted: May 09 2019 at 6:30pm
I do not know what the deciding factor is and a lot of women have radiation. I did not have it either time. They talked about it with my first primary but decided against it in the end. Hopefully,  someone more knowledgeable will have an answer for you. 

Blair


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Lump found 11/08
DX: 2/09 @52 TNBC
L. Mast. 3/26/09, SN-, BRCA-,
4.5 cm (post surgical)T2NOMO
Chemo: 4/09-10/09 Taxol x 12,
A/C x 4, No rad.No recon. NED 1/17. New Primary right breast TN, 2/2018.


Posted By: Kellyless
Date Posted: May 09 2019 at 7:40pm
Request a consultation with a radiation oncologist. They will be able to break down your options, the pros and cons and give you clarity. 

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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: beejack209
Date Posted: May 10 2019 at 1:53pm
I was actually scheduled to meet with the radiation oncologist but during my appt with my medical oncologist, she said the radiologist didnít think radiation was necessary and cancelled our appt. Now Iím wishing we had still met to discuss it. I will request a new consult. Thank you!


Posted By: 123Donna
Date Posted: May 14 2019 at 8:06am
Hi Beejack,

I think this is a grey area where there is probably some benefit to a small percentage of women, but the question is how to identify which ones need it vs the majority that don't need radiation?  I was like you 10 years ago with having a bilateral mastectomy and clear nodes (0 out of 5).  What I learned was that 95 to 96% of tumors drain to the sentinel nodes, but not all.  I fell into the small percentage that drained elsewhere.  Mine went to a regional node so even if I had the standard radiation therapy, it wouldn't have hit the regional nodes where mine drained to (internal mammary nodes).  I would have had to have the standard radiation therapy plus hitting the regional nodes to mop everything up.  At the time we didn't know there were a few cells hanging out (MRI was clean).  I don't think any radiation oncologist would have recommended treatment for early stage bc with clear nodes for me either.

Here's a few older threads talking about this subject:

http://forum.tnbcfoundation.org/radiation-and-possible-benefits-of-rni_topic10437.html" rel="nofollow - http://forum.tnbcfoundation.org/radiation-and-possible-benefits-of-rni_topic10437.html

http://forum.tnbcfoundation.org/radiation-after-bmx-node-negative_topic11897.html" rel="nofollow - http://forum.tnbcfoundation.org/radiation-after-bmx-node-negative_topic11897.html




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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: beejack209
Date Posted: May 14 2019 at 4:03pm
Given what you know now, would you have pushed for radiation back then?


Posted By: 123Donna
Date Posted: May 14 2019 at 6:27pm
Only if the radiation would have hit where my recurrence was located.  The recurrence was to a regional node, internal mammary nodes, and the normal radiation areas wouldn't have hit that area so I feel like it wouldn't have helped me.  I too was told that since I had a mastectomy and all clear nodes, that radiation wasn't needed.  I just fell into the 4% of people with clear nodes that the tumor actually drained elsewhere. 


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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: James123
Date Posted: May 16 2019 at 8:47pm
with LVI i would get Radiation 


Posted By: 123Donna
Date Posted: May 16 2019 at 8:53pm
James123 is correct.  I know you say you had no positive nodes and this study talks about 1 node, but with LVI I'd consider the possibility of radiation or get another opinion.

Conclusions

For patients with T1Ė2 and N1 stage breast cancer, PMRT can decrease locoregional recurrence and increase overall survival only in patients with lymphovascular invasion.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110089/" rel="nofollow - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110089/


Table. Cambridge Postmastectomy Radiation Therapy Index

Score 3 2 1
Number of Positive Nodes or LVI > 4 positive nodes 1-3 positive nodes LVI
Tumor Size > 5 cm/T4 3-5 cm 2-2.9 cm
Excision Margins Pectoral muscle involvement or deep margin < 1 mm -- --
Tumor Grade -- -- Grade 3
LVI = lymphovascular invasion

https://www.medscape.org/viewarticle/570888" rel="nofollow - https://www.medscape.org/viewarticle/570888





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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: James123
Date Posted: May 17 2019 at 9:53am
Donna

I didnít read the whole study but it sounds like radiation can improve overall survival of patients with LVI and positive lymph nodes?


Posted By: James123
Date Posted: May 17 2019 at 9:55am
yes with LVI I and no node involvement I would at least get the 16 radiation treatments they offer most with no node involvement 

I have two friends with no nodes involved and no LVI and they got 16 radiation treatments 




Posted By: 123Donna
Date Posted: May 17 2019 at 11:49am
It's definitely worth getting a second opinion from another institution.


-------------
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: beejack209
Date Posted: May 17 2019 at 7:33pm
Thank you all for the advice. I got another appt set up with the original radiation oncologist for next week. If she still says no, I think I will still get a second opinion. I just donít think LVI is worth messing around with. Thanks again!



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