Mimsey,

I'm so sorry and can totally understand how frustrated you are right now. You're making decisions (reconstruction) and you don't have all the answers (radiation or not), which could affect your plastic surgery decisions. I think you are making a good decision to talk to the rad onc now and find out what's in store for you. If it is radiation, then ask your plastic surgeon what that means regarding your reconstruction?

There have been some threads in the past. The "grey" area for radiation is 1-3 nodes. With you having 3 positive nodes and triple negative, you might want to err on the side of caution and get the radiation. Here's a link talking about radiation:

Based on the findings, Dr. Whelan recommended that women with one to three positive nodes should be offered RNI, “provided that they are made aware of the associated toxicities.”

http://www.cancer.gov/ncicancerbulletin/061411/page3#f

http://forum.tnbcfoundation.org/radiation-and-possible-benefits-of-rni_topic10437.html

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

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.

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.

Chen X, Yu X, Chen J, Zhang Z, Tuan J, Shao Z, Guo X, 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.

PMID:

23576181

[PubMed - as supplied by publisher]

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 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 treatedcancer 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.