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beejack209
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Topic: Radiation following mastectomy w/ no positive node Posted: May 09 2019 at 12:58pm |
I’m 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 didn’t think I needed radiation because the LVI “is gone”. 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 we’ve got.
Edited by beejack209 - May 09 2019 at 12:59pm
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cheeks
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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.
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Kellyless
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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!
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beejack209
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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 didn’t think radiation was necessary and cancelled our appt. Now I’m wishing we had still met to discuss it. I will request a new consult. Thank you!
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123Donna
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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:
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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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beejack209
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Posted: May 14 2019 at 4:03pm |
Given what you know now, would you have pushed for radiation back then?
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123Donna
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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
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James123
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Posted: May 16 2019 at 8:47pm |
with LVI i would get Radiation
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123Donna
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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.
ConclusionsFor
patients with T1–2 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/
Table. Cambridge Postmastectomy Radiation Therapy Index
Score |
3 |
2 |
1 |
Number of Positive Nodes or LVI
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> 4 positive nodes |
1-3 positive nodes |
LVI |
Tumor Size
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> 5 cm/T4 |
3-5 cm |
2-2.9 cm |
Excision Margins
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Pectoral muscle involvement or deep margin < 1 mm |
-- |
-- |
Tumor Grade
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-- |
-- |
Grade 3 |
LVI = lymphovascular invasion
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
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James123
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Posted: May 17 2019 at 9:53am |
Donna
I didn’t read the whole study but it sounds like radiation can improve overall survival of patients with LVI and positive lymph nodes?
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James123
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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
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123Donna
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Posted: May 17 2019 at 11:49am |
It's definitely worth getting a second opinion from another institution.
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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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beejack209
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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 don’t think LVI is worth messing around with. Thanks again!
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