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Radiation after pCR??

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Katwall View Drop Down
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    Posted: Mar 05 2016 at 1:35am
Hi everyone,

I was diagnosed in September with stage 2 TNBC, no node involvement at age 30. I completed 4x AC chemo in January and had a mastectomy 2 weeks ago, I am thrilled to hear I have achieved a pCR. I still have 12 weekly taxol to go once I've healed from surgery. My oncologist and surgeon have told me that I do not need radiation but the option is there if I would like it. I can't seem to find much information on radiation after pCR especially when there is still a whole cycle of chemo to go. Has anyone heard of this? I am hesitant to forgo the radiation as I'm terrified it will return. I am happy to delay reconstruction in order to have radiation but my doctors think it is unnecessary. I am torn over that to do and would love some advice and to hear from other people about their experience. This site has helped me understand TNBC so much better.
Thank you all

Kat

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Tulips View Drop Down
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Post Options Post Options   Thanks (2) Thanks(2)   Quote Tulips Quote  Post ReplyReply Direct Link To This Post Posted: Mar 05 2016 at 2:46am
Hi Kat,

Congratulations on your pCR!  That is great news, and obviously bodes well for your prognosis!

Your doctors will have the best advice, of course (although you might also want to speak to a radiation oncologist for an opinion, too).  There is a study you might want to ask your doctors about:

"Although additional studies are needed, itís possible that adding radiation therapy may improve outcomes among women who undergo mastectomy for early-stage, triple-negative breast cancer. In the current study, the risk of recurrence within or near the breast was lower among women treated with breast-conserving therapy (lumpectomy plus radiation therapy) than among women treated with mastectomy without radiation therapy. "   

- See more at: http://ww5.komen.org/Breast-Cancer-News/Breast-Conserving-Therapy-May-Outperform-Mastectomy-Alone-for-Women-with-Early-Stage-Triple-Negative-Breast-Cancers.html#sthash.LqaxheAF.dpuf

Basically, this study was looking at node-negative TNBC women, and specifically at loco-regional recurrence.  It found that lumpectomy with radiation had better results than mastectomy alone (96% vs 90% recurrence free 5 year survival).  Presumably, the reason could be because of the effectiveness of the radiation.  Too bad they didn't compare the 3 options (lumpectomy with rads, mastectomy alone, and mastectomy with rads).  One other possible explanation for the superiority of lumpectomy/rads could be that the more serious cases chose mastectomy, so there might have been a bias towards those being higher risk cases to begin with, although all cases were node-negative, so it doesn't seem to be the case.  Anyway, I think it's a good study to discuss with your doctors.

But in the meantime, the pCR certainly means all sorts of great things about lowering your metastatic risk, so that's great.

One thing I'll add, if you do choose to do radiation, I did not find it difficult at all (except the huge inconvenience of going every day).  Nothing compared to chemo!  Of course, there is a range of experiences, but so often on forums I think people write in who need advice because they are having difficulty,  so it may seem like everyone is having a hard time, when really the people who breeze through have no reason to write so you just don't hear from them.  So I just wanted to be one voice that lets you know that there are people who don't have difficult side effects from it.

good luck with everything!
Tulips
Dx April 2015 IDC TN 2.2 cm, Grade 3, Chemo started May 2015: Taxol/Carbo then AC, Lx with SNB Nov 2015, 33 Rad Dec 2015-Feb 2016. 6 months Capecitabine starting March 2016
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Minigerkin View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Minigerkin Quote  Post ReplyReply Direct Link To This Post Posted: Mar 05 2016 at 11:04am
Hi Kat,
I agree with Tulips.  I had TNBC Stage 1, grade 3 and had a lumpectomy.  After surgery, I had DD 4 AC tx, followed by 12 Taxols.  I have now finished my first week of radiation. The daily rad tx is a breeze, I have 30 more visits to complete my treatments.  Read the study Tulips provided and make an educated decision.  Ultimately, it is up to you to hold a discussion with your health providers.  I elected to follow the advice of my doctors.

I wish you the best!
Minigerkin
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rosewater View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rosewater Quote  Post ReplyReply Direct Link To This Post Posted: Mar 05 2016 at 12:23pm
As you can see in my signature
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+
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Post Options Post Options   Thanks (0) Thanks(0)   Quote rosewater Quote  Post ReplyReply Direct Link To This Post Posted: Mar 05 2016 at 12:29pm
Oops! Accidentally hit the send button :)
As you can see in my signature, I was stage 1 node negative, grade 3. I had a bmx and was originally told by my oncologist that I wouldn't need rads. I asked for a 2nd opinion because I also had extensive lymphovascular invasion, and was very nervous . 5 out of 7 of the oncologists thought that I should go ahead with the rads, so that's what I did. I don't have any regrets. Partly, that's because I have a lot of anxiety, and I feel much calmer knowing I've done everything possible at the time. It was also much easier for me that chemo. I didn't even really mind going every day. It's a drag, but much less of a drag than everything else we've been through!
That's a really interesting study, Tulips. Makes me even more secure in my decision. Thank you !
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+
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Guests View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: Mar 06 2016 at 2:36am
Iam having double mastectomy on tuesday and beginning reconstruction at the same time. I was told that you want these temporary inserts in there because your skin shrinks during radiation therapy. The temporary ones dont interfere with the radiation at all because they are filled with air. Then when you are done with radiation and are all healed up they replace the insert with a silicone one or whatever kind. The second surgery to put in the permanant one canusually be done in an outpatient surgery ctr.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Mar 06 2016 at 8:36pm
I don't know exactly what you are talking about, but my wife's surgery team did a single mastectomy and a small saline implant at the same time. The masectomy was about an hour and 1/2, and the plastic surgeon did a skin-pouch/saline small implant which took about 2 hrs. My wife said the surgeon was leaving skin for the plastic surgeon to follow...
to me... very complex...

 They did a sentinel node biopsy at the same time. The first node looked suspicious, so the took out 5, in that first line.

She is small-breasted.

They said radiation "can" affect this implant, even melting, but "they can fix that" The radiologist-oncologist said the radiation equipment -beam pattern will avoid that.








Edited by gordon15 - Mar 06 2016 at 9:08pm
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: Mar 06 2016 at 10:01pm
They describe it at a website called breast cancer.org. The Dr said if you have reconstruction after radiation it is much more diificult because the radiation effects the skin and he sometimes has to take skin from your thigh to cover the implant. If you do it at the same time as the mastectomy it is better.
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