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Radiation After BMX Node Negative

Printed From: TNBC Foundation
Category: TNBC Forums
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=11897
Printed Date: Jul 13 2020 at 10:57pm
Software Version: Web Wiz Forums 12.01 - http://www.webwizforums.com


Topic: Radiation After BMX Node Negative
Posted By: Allydp
Subject: Radiation After BMX Node Negative
Date Posted: Mar 28 2014 at 4:20pm
Hi, I'm really questioning whether or not I should have radiation. My onc and BS have both said no, due to the fact that I'm stage IIa, node negative. However, my tumor is near the chest wall and my lymph nodes present with a "thickening appearance" on ultrasound. Both of these things make me very nervous. 

Also, I came across this article, which is further fueling my thoughts. It states those who choose lumpectomy vs BMX may do better based on the fact that they received radiation therapy - and that those with TNBC may benefit from radiation regardless of stage. 

http://ww5.komen.org/KomenNewsArticle.aspx?id=19327353085

So what are all of your thoughts on this? Has anyone had radiation after BMX despite being node negative? 

Thanks in advance. 



Replies:
Posted By: 123Donna
Date Posted: Mar 28 2014 at 4:28pm
Hi Allydp,

Just my 2 cents, I'd do the radiation.  I had bi-mx, stage 1, no nodes, but had a recurrence to a regional node.  TNBC is just too aggressive.  


Check out these threads:

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/bc-staging-based-on-tumor-biology_topic11719.html" rel="nofollow - http://forum.tnbcfoundation.org/bc-staging-based-on-tumor-biology_topic11719.html

Donna


-------------
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: Allydp
Date Posted: Mar 28 2014 at 4:37pm
Hi Donna, thanks so much. I plan on having a frank discussion with my BS and these articles will help back up my thoughts. I appreciate it. 

-------------
Age 33, BRCA2+
Dx 1/30/14: IDC, 2.4 cm, stage IIa, grade 3, 0/1 nodes
Chemo 2/25/14: Adriamyacin, Cytoxan, Carbo, Taxol
Surgery 8/14: BMX with Reconstruction, Prophylactic Salpingo-oophorectomy


Posted By: Tina12
Date Posted: Mar 28 2014 at 5:01pm
Hi Allydp,

I would also advise you to get the radiation therapy after the BMX. In my case my tumor was 4 cm and node negative. My tumor is probably bigger than yours but my surgeon said that there have been studies showing that radiation after BMX has shown to help in particular for TNBC. He said some radiation oncologist wouldn't recommend it after a BMX unless the tumor size > 5cm but he encourages me to get the radiation. I just recently started chemo but will be having radiation. 


Posted By: Allydp
Date Posted: Mar 29 2014 at 6:42am
Thanks, Tina. That's another reason my BS and onc told me I don't need radiation - because my tumor was only 2.4. They said anything above 3, they'd consider it. My BS admitted I was kind of in a gray area, so I take that to mean she should have no problem consenting to radiation in my case. Or at least I hope. I have my mind pretty much made up at this point. 

I've found 3 additional articles quoting studies on this very fact. I thought I'd include them in case someone was reading along. All 3 state those who receive radiation do better. 

http://jco.ascopubs.org/content/29/21/2841.full

http://www.cinj.org/sites/cinj/files/documents/IncreasedRiskLocoregionalRecurrence.pdf

http://www.ncbi.nlm.nih.gov/pubmed/23335622


-------------
Age 33, BRCA2+
Dx 1/30/14: IDC, 2.4 cm, stage IIa, grade 3, 0/1 nodes
Chemo 2/25/14: Adriamyacin, Cytoxan, Carbo, Taxol
Surgery 8/14: BMX with Reconstruction, Prophylactic Salpingo-oophorectomy


Posted By: nancykind
Date Posted: Mar 29 2014 at 11:34am
you are always entitled to 2nd opinions, too.   radiation isn't fun but it has a function.  best of luck with all!  


-------------
Lg lump never visible on any films but found 9mm. Lump 1/25/12, DX 1/31@50yrs IIIC/TN/DCIS/INV, Margins Unclr, Ki67 40%,Gr2. MX L 2/24. 3.1cm total. 11/17nodes. AC/T 2xWk,33rads. 12/12 MX R. 9/13 NED!


Posted By: nonna1642
Date Posted: Apr 02 2014 at 12:52am
Dear Allydp,

I had radiation after my chemo but then my tumor was 5.1 cm. I am almost 4 years out from surgery. Best to you in your decision.

nonna


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Dx: age 70 IDC TNBC Grade 3 5/10 left mastectomy Stage IIB 5.1 cm no reconstruction followed by chemo of Taxotore & Cytoxin then radiation


Posted By: Fighting Mama
Date Posted: Aug 27 2015 at 7:54am
I know this is an old post but did your get the rads?! I am having the same issue right how! They keep saying no but I am grttingn a second opinion!


Posted By: ImaJ
Date Posted: Jan 13 2016 at 10:02am
I knew I would find some answers on this forum.  I just finished chemo a month ago, had my lumpectomy last week and am due to start radiation next month.  I was questioning whether I need radiation at all since I was node negative, but doctors had told me in the very beginning that I would need it regardless of chemo outcome because my tumor was big, or 3.5cm.  It shrunk down to 4mm with chemo, which they tell me was good, and I got clear margins from surgery, so I started wondering if radiation was necessary.  You guys have helped me feel at ease with doing radiation, thanks!


Posted By: Kellyless
Date Posted: Jan 13 2016 at 2:09pm
I certainly don't regret the radiation in the least.  I was lucky in that I never got more than a bit of a "sunburn" effect and "fatigue".  After the surgery nightmare and chemo,  radiation was for me a pretty peaceful experience.  And I truly did have the sense of............"well, I gave it all I could, time to move on" afterwards.  If I'd skipped the rads I don't think I would've had that feeling so much, and that feeling was worth a lot at that point, after all "that". 


-------------
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: pooja
Date Posted: Feb 02 2016 at 10:50pm
Hi
Had mrm on 20/1/16 after 8 cycle chemo histopathology report shows no residual of malignancy my Dr. Suggesting 15 cycles of radiation .l am wondering should I opt for radiation or not ? Can any one help
me ?


Posted By: 123Donna
Date Posted: Feb 03 2016 at 11:45am
pooja,

What was the size of your original tumor?  Were any nodes affected before chemo?  



-------------
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: pooja
Date Posted: Feb 07 2016 at 5:12am
Hi
My original tumor size was 22cm approx and node was involved but after chemo there is no residual.


Posted By: gordon15
Date Posted: Feb 07 2016 at 7:32pm
Pooja, I posted some information regarding the need for radiation after surgery, my wife is having it soon...
Here are 3 recent studies that may help re: radiation after surgery/mastectomy

(2012) http://theoncologist.alphamedpress.org/content/18/2/141.full" rel="nofollow - http://theoncologist.alphamedpress.org/content/18/2/141.full        

(2014)  http://www.tnbcfoundation.org/tnbcnews-postmastectomy/" rel="nofollow - http://www.tnbcfoundation.org/tnbcnews-postmastectomy/


(Nov 2015) http://www.redjournal.org/article/S0360-3016%2815%2901366-8/fulltext" rel="nofollow - http://www.redjournal.org/article/S0360-3016%2815%2901366-8/fulltext

It seems like the standard is: if any lymph node involvement, then radiation is recommended, even if there was a-pCR, after chemo ( the chemo killed it) this is for TNBC.




Posted By: 123Donna
Date Posted: Feb 07 2016 at 11:07pm
Radiation is used to mop up any remaining cells that may have remained.  We only get one chance to do everything the first time and hope it doesn't return.




-------------
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: pooja
Date Posted: Feb 08 2016 at 7:40am
Thanx for the information.I will definitely to do everything possible to overcome it.any suggestions regarding special diet to avoid side effects during radiation.


Posted By: 123Donna
Date Posted: Feb 08 2016 at 8:05am
For me, radiation was easier than chemo.  I don't remember anything about a diet affecting the side effects.  With 15 treatments, you might not have too many side effects.  Wishing you the best.

http://www.breastcancer.org/treatment/radiation" rel="nofollow - http://www.breastcancer.org/treatment/radiation




-------------
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: Panda79
Date Posted: Apr 25 2016 at 7:06pm
I'm having surgery in two days (BMX+prophylactic salpingo-oopherectomy) and my surgeons and oncologist say that the Tumor Board reccommends that I have radiation.  However I met with a radiation oncologist who thinks I most likely will NOT need it, given my tumor size, node negative.  It's messed with my reconstruction plans, as now the PS can't use the allogenic material and implants will be more droopy.  Which is probably more natural, anyway, but radiation wasn't mentioned until after I'd finished ten infusions of neoadjuvant chemo, so we had mapped out the procedure differntly.
Thirteen years ago I had a lumpectomy on my left breast, had chemo and radiation, and then was diagnosed last October with a 2.4cm tumor in my right breast, so my thought is why have to rush the tissue expander fills just to do radiation within their timeframe, and increase the chances of scarring, encapsulation, and implant failure?  Anyone who's been through tissue expanders and reconstruction and radiation who can share experience or thoughts?  Allydp, did you have all?


Posted By: gordon15
Date Posted: Apr 25 2016 at 8:00pm
My wife had mastectomy and plastic surgeon in one surgery, where the surgeon left skin for her afterwards, a small saline implant, which she said could be expanded later after chemo and radiation. After 32 radiation, she hasn't had any problem with the implant, but they did say after surgery sometimes it melts to the chestwall, (and can be fixed) I think the radiation -oncologist's are amazing, the way they do the template,  to avoid this.


-------------
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017


Posted By: Gigi123
Date Posted: Aug 19 2018 at 8:27am
I know this is old post but hoping someone will respond I had decided against radiation treatments but now second guessing. I had 1.3 cm grade 3 node negative. Bilateral mastectomy good margins 16 Chemo treatments will be complete on Thursday. Surgeon and chemo doc say no radiation. Any opinions from you all?


Posted By: Fighting Mama
Date Posted: Aug 19 2018 at 10:26pm
Hi Gigi,

I don't frequent the board much these days but I was I saw the email that someone posted and I wanted to respond to you.
I did not end up getting radiation. I was stage 2A...I had chemo, bmx and lucky enough to get a PCR. I was geared to do the radiation... the docs all planned for it but after my pcr and being node negative my plan changed. I was so upset. I thought I needed it. I sent my case to the tumor board at Dana- Faber and they came back with a unanimous no. But still I pushed and got a second opinion at MGH...again they said no. The general rule I guess are if you have node involvement then you get rads (regardless of a pcr).
For me a lot had to do with my age. I was 30 at the time and they felt rads would do more harm then good.... I was scared and upset but I ended it there. I prayed what I did was enough. I still hope it was. I'm 3 years out. So far, so good :) I'm still scared I didn't do enough but I've moved forward. You have to make a choice and then live. You are in the thick of it but someday you won't be. Do what you need to do and make peace with that decision. Good luck to you <3


Posted By: Gigi123
Date Posted: Aug 21 2018 at 8:17pm
Thank you so much for sharing your experience. I do not mean to sound stupid but what is pcr? My surgeon and oncologist are very confident with no radiation but of course the radiation oncologist says yes. I was feeling good with no radiation but when realizing my last chemo I started second guessing myself. I am kind of scared to go from 7 months of fighting this cancer to doing nothing.


Posted By: MJK
Date Posted: Sep 30 2018 at 7:12pm
I had the bmx,completely clear before and after surgery.12 rounds of Taxol did the job.Having radiation to clean up any cancer cells not detectable.I was told it was a grey area and my decision: My surgeon said watch it/ the rad Dr said it was my decision but if it was his wife,yes/ My onc said I should do it. 3 opinions but left up to me. I have lost my hair,breasts and the year fighting this...I choose to go all the way with this fight.No problem with the radiation. No regrets of not giving this my all. That was my decision I had to make. So many,too many of my friends with cancer.Love them all for sharing their experience and hope with me. Radiation was a easy one for them,giving me strength to go for it. Hope this helps in your decision.



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