Radiation + RNI

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Topic: Radiation + RNI

Posted By: mainsailset
Subject: Radiation + RNI
Date Posted: Jun 11 2011 at 9:25pm

This years ASCO publication has an interesting piece for those looking at radiation treatment...the benefit for those with TN with 0-3 positive nodes is worth adding the RNI

http://chicago2011.asco.org/ASCODailyNews/triplenegative.aspx - http://chicago2011.asco.org/ASCODailyNews/triplenegative.aspx

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dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear

Replies:

Posted By: dmwolf
Date Posted: Jun 11 2011 at 10:05pm

I think the study is on women with 1-3 nodes, not 0. (just in case the no-positive-node people start wanting to kick themselves)
d

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DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.

Posted By: dmwolf
Date Posted: Jun 11 2011 at 10:08pm

I just read it again. There are some women in the study with 0 nodes, but it doesn't say whether they benefited as well.

It would be good to get more detail on this.

d

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DX 2/08@43 stg II IDC; gr2,0 nodes. Neoadj chemo, first ACx2 (fail) then CarboTaxotereX6(better). Lump, Rads done 11/08; Clodronate. False alarm queen: PetCT lung & TM marker. NED. PBM w/recon 9/10.

Posted By: Rue Marbeau
Date Posted: Jun 11 2011 at 11:14pm

Posted By: mainsailset
Date Posted: Jun 12 2011 at 11:12am

Denise, I noticed that too and was unsure how to state it, I've a personal belief that the -0- gals should be statistically treated carefully and perhaps not, as the cynic in me thinks, added into a a report like this to bring up the success markers. Forgive me if I've overstated, just sayin.

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dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear

Posted By: 123Donna
Date Posted: Jun 12 2011 at 11:56am

Interesting study as this is the type of radiation I'm getting now. It's pretty aggressive and wonder how you determine the need for node negative women? The article stated: Women with highrisk, node-negative breast cancer were also eligible. Could "high risk" mean TNBC or maybe any Grade 3 breast cancer?

With having a regional node recurrence, all 3 radiation oncologists that I met with recommended this type of treatment.

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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: mainsailset
Date Posted: Jun 12 2011 at 12:14pm

Donna, I was thinking of you when I saw the article. It's my understanding that for most in the field when they use the words 'high risk' that TN is always at the top of that list. It's such a relief that you are having the RNI.

Posted By: 123Donna
Date Posted: Jun 12 2011 at 12:31pm

Mainy,

I wonder if this is the study the rad onc was referring to when I went to MDA? He mentioned a study supporting RNI therapy. It's a tough therapy because they are hitting a lot of areas. With RNI and WBI, I was in the machine about 11 minutes each day. Now that I'm getting my first boost to the mx scar area and IM node, it's only about 3.5 minutes. I cringe when I think of all the radiation I never wanted to get, but realize it's necessary in this fight.

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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: Karen O
Date Posted: Jun 12 2011 at 4:15pm

Donna: I started getting rads to my shoulder last week and soon, to my spine (after an MRI to specify area). I have lesions now in my lower jaw, two areas on skull and a small one in left hip (changes from scans of 6 months ago, so it is progressing); but they haven't said if they can radiate those as well. I cherish any treatment that will kill and stabilize this disease that is running rampant in me! I'm going to read more about your RNI, I guess I'm getting regular radiation (don't know what the differences are). Will watch this discussion if someone can comment on the benefit of radiation therapy during metatatic recurrent disease like mine. So far, no organ involvement, thank God!

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Stage III ICD/TNBC 9/07; lumpectomy A/C/Taxotere+rads; Stage IV bone mets 12/10. Xeloda and Gemzar, no good. On Navelbine + rads

Posted By: Karen O
Date Posted: Jun 12 2011 at 4:18pm

Ok, I read the article and understand a little better what RNI and TBR mean... I had total breast radiation x 35 after my lumpectomy and chemo in 2007. But, I am still interested in anyone out there with recurrent disease with bone mets and how they are being treated with radiation. I had rads to my lower spine (L4) in January, and the recent scans show total stabilization of that area, and my pain was gone. Now, I'm just hoping that the spread of my disease in my spine can be stopped as it is starting to be very painful, and I fear being an invalid if we can't preserve the integrity of the bone there. Anyone?

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Stage III ICD/TNBC 9/07; lumpectomy A/C/Taxotere+rads; Stage IV bone mets 12/10. Xeloda and Gemzar, no good. On Navelbine + rads

Posted By: mainsailset
Date Posted: Jun 12 2011 at 8:53pm

Karen, if I forget to bump this article/thread please go ahead and bump it as I think your issues are tremendously important and it would be a waste to see this thread get lost.

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dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear

Posted By: Karen O
Date Posted: Jun 14 2011 at 8:47am

Bumping this up. Anyone getting rads to bone mets and how is working for you??

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Stage III ICD/TNBC 9/07; lumpectomy A/C/Taxotere+rads; Stage IV bone mets 12/10. Xeloda and Gemzar, no good. On Navelbine + rads

Posted By: 123Donna
Date Posted: Jun 14 2011 at 6:37pm

Karen O wrote:

Bumping this up. Anyone getting rads to bone mets and how is working for you??

Karen, Have you seen this link to Living Beyond Breast Cancer podcast?

http://lbbc.org/Event-Archive/2011-05-01-Bone-Mets - http://lbbc.org/Event-Archive/2011-05-01-Bone-Mets

Bone Mets

05/01/2011

Speaker: http://lbbc.org/Staff-Advisory-Board-and-Expert-Bios/Brufsky-Adam - Adam Brufsky, MD, PhD

Learn about treatment options for breast cancer that has spread to the bones. Get strategies to limit side effects, manage bone pain and maintain bone strength. Understand screening tests, and get updates on clinical trials studying new treatments and quality of life.

Download the Podcast:

http://lbbc.org/content/download/3029/27383/file/Bone%20Mets.mp3 - Bone Mets.mp3 18.16 MB MP3 File

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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: 123Donna
Date Posted: Jun 14 2011 at 6:40pm

International Study Tests Additional Radiation Therapy for Breast Cancer

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

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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: Karen O
Date Posted: Jun 15 2011 at 8:42am

Thanks for the links! Good info. It's hard to find good stuff on the internet when you put in radiation and bone mets... too much junk/info. Thanks again Donna!

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Stage III ICD/TNBC 9/07; lumpectomy A/C/Taxotere+rads; Stage IV bone mets 12/10. Xeloda and Gemzar, no good. On Navelbine + rads

Posted By: 123Donna
Date Posted: Jul 22 2011 at 12:17am

bump

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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: 123Donna
Date Posted: Aug 04 2011 at 7:50am

mainsailset wrote:

This years ASCO publication has an interesting piece for those looking at radiation treatment...the benefit for those with TN with 0-3 positive nodes is worth adding the RNI

http://chicago2011.asco.org/ASCODailyNews/triplenegative.aspx - http://chicago2011.asco.org/ASCODailyNews/triplenegative.aspx

Posted By: 123Donna
Date Posted: Jan 01 2012 at 7:16pm

Bringing this subject forward again as there are some recent discussions about radiation on this forum.< ="text/" ="" ="/B1D671CF-E532-4481-99AA-19F420D90332etdefender/huidhui.js?0=0&0=0&0=0">

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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: debB
Date Posted: Jan 05 2012 at 8:49pm

Thanks Donna, I had missed this the first time around!

Deb

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Dx 4/29/11, 46 yrs old, 3.9 cm tumor, Stg 2 Grade 3 chemo 4 rounds DD AC, 12 weekly taxol, finish. Lumpectomy, 2mm residual tumor. 37 rounds rads completed. Cisplatin/PARP trial

Posted By: mindy555
Date Posted: May 10 2012 at 11:40am

Bump

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Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: snickers
Date Posted: May 17 2012 at 12:32pm

Hello
I was recently diagnosed with TNBC and just finished chemo last week. I had 0 lymph node involvement, with a bi-laterial prior to start of chemo. I do have vascular invasion. My oncologist stated that having radiation for 0 lymph node involvement is not a common procedure and it is a very "grey area" whether the risk of having radiation exposure out weighs the risk of potential recurrence. I am in a huge dilemma whether or not to have radiation. Chemo kills all the loose cancer cells running rampant in your body so what does the radiation do for a person with 0 lymph node involvement? Help!

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DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: 123Donna
Date Posted: May 17 2012 at 12:41pm

Snickers,

That's a very good question and agree it's a grey area. In my personal experience, I had a bi-mx for a 1.5 cm tumor with 0/5 nodes (clear) back in 2009. Since I had no lymph node involvement, radiation was not suggested. In 2010, I found out I had a recurrence to an Internal Mammary node on the opposite side of the original tumor. Had they given me radiation after the original diagnosis back in 2009, they would not have hit the Internal Mammary nodes as they usually don't treat the regional nodes unless they suspect that they might be cancerous. Just wanted to share.

Donna

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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: snickers
Date Posted: May 17 2012 at 12:46pm

Donna
To clarify for me, even if you would have had radiation, they would not have done the area that you now have a recurrence in?
If I decide to do radiation would they treat the nodes under my arm pits or do radiation around my scar area?

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DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: turtle
Date Posted: May 17 2012 at 1:31pm

Snickers,

I am in the same boat as you, with no node involvement (but with lymphovascular invasion present), but considering radiation...actually, I have decided to go ahead and do it, even though, as you state, the medical literature is half-for and half-against this in node-negative patients. My feeling however, is that triple negative breast cancer is particularly aggressive and should be treated as such. The issue of another cancer arising at a later date as a consequence of radiation is a real issue, but what the doctors all seem to say is, lets cure the cancer you have, and worry about what may come up in 10 years at that time. They see buying you 10 years of life vs. potentially 3 as the advantage of aggressive treatment. Ultimately though, the decision will rest with you, and what you feel comfortable with.

Hope this helps

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DX IDC TNBC 1/15/12 @ 46; MRI 2.4cm gr3 BRCA2+ 6174delT; LMX 1/31/12 2.5cm, pT2pNO(i)pMX, lymphovascular invasion present; 2/20/12 TAC X 6; 7/2/12 Rad X 25; 9/27/2012 2nd mastectomy & BSO surgery

Posted By: 123Donna
Date Posted: May 17 2012 at 2:00pm

Yes, normally they just treat the breast and axilla, but don't hit the regional nodes, like the Internal Mammary nodes. The regional nodes are usually hit if there's evidence of cancer in them. My MRI pre-surgery showed no evidence of cancer in the nodes.

I would think they'd treat the nodes under your arm (axilla) plus the scar area. Those are the most common areas treated with radiation.

Donna

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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: mindy555
Date Posted: May 19 2012 at 12:22am

Same dilemma here. I'm bamboozled as to which route to take. After meeting with an oncology radiologist @ MD Anderson, it was strongly recommended no radiation due to my risk ratio- purely based on being stage II with no node involvement. I'm having real anxiety over this. My original pathology showed no vascular invasion. I've procrastinated a second RO opinion. Now's the time to do it since it's been almost 3 months since surgery. I'm getting my MO's take since I believe from what she said she expected I would indeed receive radiation. I really NEED to figure this out. Snickers.. and others facing this decision.. It's quite unsettling, I know.

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Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: mindy555
Date Posted: May 19 2012 at 12:37am

Oops, 2 months since surgery. Chemo brain at its finest.

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Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: mindy555
Date Posted: May 19 2012 at 1:05am

Turtle.. You're so right. Ultimately it's our decision when stuck in the gray area. We all have to find our own comfort zone and live with that decision. I'm particularly sensitive to secondary cancers. My mom and brother both had adult leukemia. My bro was 6 years younger than I am. It was devastating.. heartbreaking. Then my dad passed with pancreatic cancer. Not a great family history. The RO at MDA said they've never seen a recurrence (local or distant) with TN at MDA in my situation (same stats w/no rads). THIS truly surprised me. Later I thought.. perhaps those patients went elsewhere?!?

I've always felt strongly you must treat this disease aggressively upfront.

Secondary cancers are only one among other risks- such as pulmonary and heart issues. I'm no spring chicken. It seems with today's sophisticated and targeted radiation the latter wouldn't be a major issue. I then filter in being BRCA positive and the added radiation. I'd love to hear Steve's unprofessional take. I've located abstracts showing less locoregional recurrences among BRCA+ triple negatives who receive radiation- both w/ lumpectomy and bilateral mastectomy.

Clearly in a gridlock. Another consult at OU Medical is in order I 'spose.

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: snickers
Date Posted: May 19 2012 at 10:23am

Ladies
I have spoken with my oncologist, who then spoke with a leading oncologist/teacher/researcher at Dana Farber, who both said it is a grey area, but SOME (not all) radiology oncologist will suggest radiation even if there is NO lymph node involvement and ONLY if there is vascular invasion present. The "Law of Unintended Consequences" (to quote my onc) is that you as a patient must weigh the pros and cons of radiation against the risk factors and make an intelligent decision. I spoke with my surgeon yesterday (who did my bi-lat) and he also said it is a grey area and having radiation after a bi-lat is NOT the standard care of treatment. I have a meeting with a radiologist onc next Wednesday afternoon to get his opinion and then I will carefully weigh the pros/cons of having radiation therapy. When I had the bi-lat there was a "clear margin" in the tissues so I guess my main question to my radiation onc would be: "Since all the tissues/vessels were removed during my bi-lateral and I have had chemo already what would radiation do for me? In other words, IF the cancer had already escaped through my vessels PRIOR to the bi-lateral, and now my chances of getting a reoccurrence is less than 10% due to my bi-lateral why would I need radiation? What would the radiation be "attacking." Those pesky vessels that might have sent the cancer into my system have been removed." If he can answer those questions to my satisfaction and tell me that having radiation and the risks associated with it would not do me much good for my health and would not decrease my likelihood of reoccurrence by a substantial amount I am NOT doing it. I have to be comfortable that I have done all I can have done to stop the advancement of this aggressive disease and then step back, take a deep breath AND ENJOY LIFE!!! I think the media, medical journals that get published so quickly by "upcoming super doctors" do not have enough information prior to publishing their articles. So be careful what you read and how long ago the publication was printed. If you have a good relationship with your doctors and trust them, they will give you their honest opinion, then as a patient, you must ultimately decide what to do. So......I am waiting until next week to talk with my radiation oncologist, then my oncologist wants to talk to me after that appointment and we will sit down together and talk.

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DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: 123Donna
Date Posted: May 19 2012 at 12:19pm

Snickers,

Your thinking and analysis are right on target. I know that having radiation in 2009 would not have prevented a recurrence for me. Those cells had already escaped the tumor prior to my surgery. They were just a few cells that didn't show on the MRI or CT scan prior to surgery and chemo. All treatment has it's consequences and we just have to look at the pros and cons in each of our situations and make the best decision. I know I struggled with the "what could I have done differently" when I had the recurrence, but have come to realize that my situation was unusual and sometimes just happens as this cancer doesn't always play by the rulebook. Sigh. . .

Donna

Posted By: Lorene
Date Posted: May 19 2012 at 1:03pm

To add my personal experiene & data to the dilemma you're discussing on radiation or not, I did have radiation to one breast. I did have 3 positive lymph nodes removed during b/c surgery pre-chemo. I also had vascular invasion. I'm 10 yrs out from b/c in 2001 with no recurrence or any obvious effects from the radiation at this point.

You ladies are displaying courage in your hard decisions & positive convictions for those who follow. My Best to you in those decisions,

Lorene

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dx10/01@age59,IDC TNBC, St.IIB,Gr3,2.5cm,3+nodes, epirubicin,5FU,cytoxan,33Rads,No recurrence, 2018

Posted By: denise07
Date Posted: May 19 2012 at 11:57pm

Lorene,

I just have to say 10 years out that is a big factor for us. Thankyou and CONGRATS!!!!!!

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DX Idc 10/07,st2,gr3,2/6 lymphnodes

Posted By: Lorene
Date Posted: May 20 2012 at 9:48am

Thank You, Denise. . . and Congratulations to you! I see from your stats you're almost 5 yrs!

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dx10/01@age59,IDC TNBC, St.IIB,Gr3,2.5cm,3+nodes, epirubicin,5FU,cytoxan,33Rads,No recurrence, 2018

Posted By: SagePatientAdvocates
Date Posted: May 20 2012 at 12:19pm

Dear Lorene,

It is absolutely marvelous that you shared your 10+ years of survival with us...I wish you many, many, many, many, many (if you can make it longer..great.. Smile

) more decades in good health. It is so important for our community to hear about long term survivors. In August my daughter will be 8 years out.

I also agree with what you wrote on "hard decisions"....this is all so very, very hard.

warmly,

Steve

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I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates

Posted By: mindy555
Date Posted: May 20 2012 at 2:58pm

Snickers- Please keep us posted on what you learn and decide. This first hand info you've relayed is extremely helpful to me and others reading. You're right on target with your next questions.

Lorene... a HUGE HAPPY CONGRATS to YOU! What a blessing...10 years! Thanks a million for sharing your success.

Steve.. Congrats and Thank Goodness your daughter is doing so well. As I thought I understood, she didn't have radiation. I'm grateful she's 8 years out. Absolutely FANTASTIC! Well on her way to the 10 year mark too.. with many, many more years to come!

My risk assessment is at 8%. The MDA RO personally thought this was high for me.. and more like 5%. I don't place too much significance on numbers, rather view them as general guidelines.

A warm thanks to all who've contributed to this discussion. I'll share anything news-worthy from the upcoming 2nd RO consult. --Mindy

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Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: snickers
Date Posted: May 20 2012 at 4:14pm

Hi All

Okay, I have also spoken to my radiologist who did my mammo, biopsy, etc. today (yes, Sunday, she gave me her private cell number) and she told me NO on the radiation. There is many side effects (even though they do cover the area) such as bone deterioration, healthy tissue damage, potential lung and heart damage. She said for me, based on my pathology lab reports (0 lymph nodes, no muscle, skeletal intrusion and clear margins of tissue when they did my mastectomy) that the risk is too great for the results. Yes, I have vascular invasion, but all those tissues have been removed that had the cancer and hopefully the chemo killed any of those pesky cells IF they did travel through the blood vessels. Most cancer cells travel to the lymph nodes first, but even if some did travel through the vessels and into my body, the chemo and my natural immune system SHOULD (not guaranteed) kill them off. With a mastectomy it is like scooping the ice cream bowl clean, leaving nothing left. Yes, small chance of another breast cancer later on, but very small chance and having the radiation would not stop that from occurring. Yes, I am still seeing a radiation onc next week to get his take on it, but so far all the below professionals are against it:
my chemo onc
my radiologist doctor who performed my mammo, ultra sound and biopsy
my surgeon who performed the bi-lat
leading TNBC onc from Dana Farber (who my chemo onc contacted)
I have one more piece to fit into this complicated puzzle and that is the rad. onc who I see this coming Wednesday and will see what he says.
Knowledge is powerful and once you speak with all your physicians and get their take on it, you ultimately must make up you own decision. Yes, doctors will advice you on the course they think is right, but in the end it is your decision. I will carefully weigh the pros and cons of doing radiation if given the choice OR my rad onc might tell me NO and if that is the case, NO it will be.
I will keep everyone posted.....
I will also have a talk with one final "person" and that is God. I will pray and ask him to give me the wisdom and strength to make the right decision and I will know without a doubt what He says to me.

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DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: mindy555
Date Posted: May 20 2012 at 4:30pm

My very best to YOU, Snickers. Thanks so much for the update!

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: SagePatientAdvocates
Date Posted: May 20 2012 at 5:25pm

Yes, Mindy..your memory is correct...my daughter did not have radiation...she was Stage Ib...and no lymph node involvement. She had bilateral mastectomies and she was advised that she did not have to have radiation therapy.

Good luck with your decision making, Snickers and I agree this is ultimately a personal decision and, as usual, whatever someone on this forum decides it is a choice that is respected.

warmly,

Steve

Posted By: Lorene
Date Posted: May 20 2012 at 11:00pm

Oh, thank you, Steve, and how wonderful to hear the (almost) 8 years for your daughter!!

Thank you too, Mindy!

As many of us probably, at the beginning, I couldn't imagine a 10th anniversary. It was so far away, and so much to overcome. I was fearful. But as I thanked God for each obstacle He brought me through, I began expectantly watching God work. He gave me "moments" to enjoy, all worries out of my mind for a while.. a peaceful morning walk feeling the warm sun on my back. . . a new and "only" granddaughter, now 2, I've had time with who has reminded me of all things good and loving. My "moments" continued until it had been 10 years! I pray each of you have your "moments" blessings too, and I believe, before you know it, 10 years will have passed!

Lorene

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dx10/01@age59,IDC TNBC, St.IIB,Gr3,2.5cm,3+nodes, epirubicin,5FU,cytoxan,33Rads,No recurrence, 2018

Posted By: mindy555
Date Posted: May 21 2012 at 11:58am

It's a very personal decision indeed.

Lorene - I love your attitude. Enjoy your adored granddaughter! Bet you're having SUCH FUN with her!!

Snickers.. Yes.. knowledge IS power. Even though I'm fairly certain I know in my heart what's right for me, other opinions to gather as much info necessary is not only critical in the decision making process... but for ultimate 'peace' in 'whatever' that decision may be.

Best to All,
Mindy

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: turtle
Date Posted: May 21 2012 at 12:09pm

Snickers,

Not to put a wrench in your decision, but the significance of finding lymphovascular invasion in your tumor (as well as in mine), is that it means that some of the cancer cells found a way to get out of the original tumor, before any treatment (surgery, chemo, etc) was done. What no one knows is where they went...if they weren't found in the lymph nodes (in your case, as in mine), are they hanging out locally (in the skin, or an internal node)? Did they go to some distal site, where hopefully the chemo killed them? The answer is, we just don't know. Thus, just to be really sure, in case they are too stupid to spread throughout the body, but are hanging out in some local spot, treatment with radiation therapy just might get the last of them. It is my personal feeling that the significance of lymphovascular invasion should not be underestimated, so again, in my case, I am willing to take the risk of adverse side effects and do the radiation. But it is not a guarantee either. You can do the radiation and still have a local recurrence. It's just the crap shoot we all are now faced with.

Posted By: snickers
Date Posted: May 21 2012 at 2:06pm

Mindy
So what have you decided? Are you going to do radiation? I will let you know after this Wednesday what I decide.
thank you!

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: mindy555
Date Posted: May 21 2012 at 2:14pm

Snickers,

I'll make a final decision when I meet w/the RO at OU Medical on Tues of next week. In the meantime I'm talking to my regular radiologist at the Breast Center. I'm leaning towards NO.

Whatever your decision, I know it will be well thought-out by and reinforced by The Man Upstairs. Thumbs Up

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: snickers
Date Posted: May 21 2012 at 2:49pm

Turtle
Just to clarify, vascular invasion present means that cancer cells were found in the blood vessels but it does not mean they traveled outside of the breast. Most (but not all the time) the lymph nodes are affected first and that is why such high emphasis is placed on the status of them. Yes, in small cases, the cancer cells could have traveled outside the breast, into the blood system and are swimming around your body. That is what chemo is for. I cannot speak for everyone, only about my case. I had a bi-lateral 3 days after I found out I had TNBC, and I had clear margins (meaning my skin, skeletal, etc) was clear of cancer. I then had a cat/PT scan a few weeks later with no evidence of mets. Of course, that can change daily. On Monday they can show clear and on Tuesday the little pesky cells are there! When a mastectomy is done, yes, there is some skin/tissue left over, but the chances of another breast cancer showing up is less than 10%. I am not meaning to unvalidate your decision of seeking radiation as I am not sure what I will be doing as of yet, but I wanted to make sure that everyone knows that having vascular invasion present does NOT mean that the cancer left the breast and is traveling throughout the blood into your body. The lymph nodes are USUALLY the first place those cancer cells attach as the lymph nodes are the "highway" to our body.

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: Grateful for today
Date Posted: May 21 2012 at 3:15pm

Hi All,

Sharing some thoughts.............
This is from the perspective of someone who had 1 positive out of 11 nodes and no pCR
and had radiation.
I feel the information from those who are in the actual situation of no nodes +/- pCR
is more relevant.........but will share anyways.

Seems the question of whether to have radiation or not with no involved nodes for TNBC is a gray
area with decisions made by patient and physician on an individual case by case basis.

Seems the question of whether to have radiation or not with no involved nodes AND a pCR for TNBC
is a very gray area with decisions made by patient and physician on an individual case by case basis.

With TNBC, there are so many gray areas where there is just not current reliable, adequate clinical
studies to help with some decisions.

I feel in these gray areas that people with their own physicians and consults will make the best
decision for them self.
At times, I acknowledge what seems to be the same situation and the same information will result in different decisions with each decision being the best for that person in their particular situation.
There can be many variables (some recognized and some unrecognized) in what seems to be a similar situation. It might be the unrecognized variables that leads the body to give one the "gut" feeling to
add to the rational, intellectual decision making process.

Sometimes, it may be helpful to consider asking one's physician:
What are the pros and cons for each option in one's individual situation......
what are the pros and cons to do radiation versus not to do radiation.

It is my opinion that those with/with a history of TNBC research and do our homework extremely well.
We take time to gather information and consult and think through and make our decisions with our
physicians.
This makes me a firm believer that those making a decision whether to do or not do radiation WILL
make the BEST decision for them self in their situation.

With caring and positive thoughts,

Grateful for today...............Judy

Posted By: turtle
Date Posted: May 21 2012 at 4:53pm

Hi All,

Snickers, you are correct in that the presence of lymphovascular invasion does not necessarily mean that cancer cells have traveled outside of the breast; it does however indicate that the cells were on the move (able to escape the tumor stroma and get into the blood stream), hence the rationale for localized treatment such as radiation therapy (again, with the caveat that this is still a grey area with respect to the use of this treatment modality for node-negative patients).

I've included a recent journal article that may be of interest to our community (sorry if it's been posted elsewhere). There are also a number of good articles posted by Lee with respect to lymph node status as well as LVI, but I don't know how to link to those older posts--they are available in open access thread.

In the paper I've posted, I was interested to note (Table 1) that many TNBC patients presented with no node involvement (62%) or no LVI (71%), similar to the other breast cancers, yet the overall survival remains lower than in other breast cancers. This reiterates what we already know, that TNBC is aggressive & sneaky, and that there appears to be less of a correlation between tumor size and lymph node status with recurrence than with other breast cancers.

At the end of the day, the bummer is that the limited treatment decisions are left up to the patient, and even when we opt to be as aggressive as possible, the ultimate outcome is really out of our hands, and would seem to be more a matter of luck than anything. I agree with Judy, that we need to do our homework, but I also think that we can't beat ourselves up if we decide one avenue of treatment vs. another, which I think we tend to do anyway (I'm trying really hard to take my own advice Smile

http://www.ncbi.nlm.nih.gov/pubmed/22544643 - http://www.ncbi.nlm.nih.gov/pubmed/22544643

http://www.ncbi.nlm.nih.gov/pubmed/22544643# - Clinicopathologic features, patterns of recurrence, and survival among women with triple-negativebreast cancer in the National Comprehensive Cancer Network.

http://www.ncbi.nlm.nih.gov/pubmed?term=Lin%20NU%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Lin NU , http://www.ncbi.nlm.nih.gov/pubmed?term=Vanderplas%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Vanderplas A , http://www.ncbi.nlm.nih.gov/pubmed?term=Hughes%20ME%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Hughes ME , http://www.ncbi.nlm.nih.gov/pubmed?term=Theriault%20RL%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Theriault RL , http://www.ncbi.nlm.nih.gov/pubmed?term=Edge%20SB%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Edge SB , http://www.ncbi.nlm.nih.gov/pubmed?term=Wong%20YN%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Wong YN , http://www.ncbi.nlm.nih.gov/pubmed?term=Blayney%20DW%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Blayney DW , http://www.ncbi.nlm.nih.gov/pubmed?term=Niland%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Niland JC , http://www.ncbi.nlm.nih.gov/pubmed?term=Winer%20EP%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Winer EP , http://www.ncbi.nlm.nih.gov/pubmed?term=Weeks%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=22544643 - Weeks JC .

Source

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. nlin@partners.org.

Abstract

BACKGROUND:

The objective of this study was to describe clinicopathologic features, patterns of recurrence, and survival according to breast cancersubtype with a focus on triple-negative tumors.

METHODS:

In total, 15,204 women were evaluated who presented to National Comprehensive Cancer Network centers with stage I through III breast cancer between January 2000 and December 2006. Tumors were classified as positive for estrogen receptor (ER) and/or progesterone receptor (PR) (hormone receptor

-positive) and negative for human epidermal growth factor receptor 2 (HER2); positive for HER2 and any ER or PR status(HER2-positive); or negative for ER, PR, and HER2 (triple-negative).

RESULTS:

Subtype distribution was triple-negative in 17% of women (n = 2569), HER2-positive in 17% of women (n = 2602), and HR-positive/HER2-negative in 66% of women (n = 10,033). The triple-negative subtype was more frequent in African Americans compared with Caucasians (adjusted odds ratio, 1.98; P < .0001). Premenopausal women, but not postmenopausal women, with high body mass index had an increased likelihood of having the triple-negative subtype (P = .02). Women with triple-negative cancers were less likely to present on the basis of an abnormal screening mammogram (29% vs 48%; P < .0001) and were more likely to present with higher tumor classification, but they were less likely to have lymph node involvement. Relative to HR-positive/HER2-negative tumors, triple-negative tumors were associated with a greater risk of brain or lung metastases; and women with triple-negative tumors had worse breast cancer-specific and overall survival, even after adjusting for age, disease stage, race, tumor grade, and receipt of adjuvant chemotherapy (overall survival: adjusted hazard ratio, 2.72; 95% confidence interval, 2.39-3.10; P < .0001). The difference in the risk of death by subtype was most dramatic within the first 2 years after diagnosis (overall survival for 0-2 years: OR, 6.10; 95% confidence interval, 4.81-7.74).

CONCLUSIONS:

Posted By: krisa
Date Posted: May 21 2012 at 5:31pm

I aways ask for guidance from the Holy Spirit :)
after what your doctors have said, i would probably follow their advice. But I say that because I did have radiation and for me it was more diffcult than chemo, side effects etal.
Take care and i know your inner voice(God) will guide you.

Posted By: snickers
Date Posted: May 21 2012 at 5:33pm

Krisa
Did you have radiation because you had lymph node involvement or vascular invasion? Lumpectomy or mastectomy?

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: krisa
Date Posted: May 21 2012 at 5:34pm

No node or vascular, but i dd have a lumpectomy.

Posted By: krisa
Date Posted: May 21 2012 at 5:38pm

I dont regret having radiation since i had a lumpectomy. My choice: keep your breast-have radiation. Lose your breast- no radiation. So many variables with each of us, makes your head spin!

Posted By: mindy555
Date Posted: May 22 2012 at 8:46am

Sorry, double post.

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: mindy555
Date Posted: May 22 2012 at 9:11am

Good posts Judy & Turtle.

The key is being familiar from every angle with your own unique situation and making an informed decision based on those facts. It's not and doubt will ever be 'a one size fits all'. I personally wouldn't rely solely on standard of care.. That's ever-changing as doctors recognize the need for more aggressive TN treatments. This is what I like about teaching cancer institutions. They often look beyond standard of care.

I went back to revisit my recorded RO consult. It's becoming clearer as I once again digest the information I was given, coupled with the facts I know to be true for my situation. And, NOT to be dismissed IMHO... a compelling risk/benefit ratio. Downloading these consultations has proved to be valuable for me. Since TN diagnoses I seem to have a degree of AADD and jump around in my thought process. Very real chemo brain is an ongoing challenge too. I blame 5-FU on the latter. But I digress.

Because radiation is so individual we all need to make a decision based on our own unique circumstances. Yes, some of us will bump into grey areas which makes for tougher choices. But, as Judy said, TN'ers by very nature are a knowledgeable group armed with research and information which will ultimately conclude well-thought-out choices. I know we need to be at peace with our decisions to finally move forward...then must let it go...

I have a handful of questions for next week which hopefully can be answered to my satisfaction.. I'll then move forward knowing I did everything as 'right as possible' for my individual case. There are no guarantees in any of this. We can only make a choice based on all the facts of pathology- pre and post in the case of neoadjuvant.. and other targeted factors.

With many here much smarter than I, I'm confident this will be true for ALL facing these difficult choices. If anything, you may run into a diverse group of doctors who are set on their own way of viewing radiation.

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: turtle
Date Posted: May 22 2012 at 11:37am

Krisa,

I'd be interested to know your negative side effects, if you'd care to share. It seems many people say radiation is easy compared to chemo, but I saw some post-radiation pics and they scared me to death. I'd be interested to hear the whole story, if anyone else has post-radiation info to share, in terms of side effects.

I also remember that someone posted about a supplement they took which helped, but it's gotten lost in the thread, and I didn't write it down, if anyone can remember?

Posted By: Grateful for today
Date Posted: May 22 2012 at 12:34pm

Hi turtle and all,

Think we might see a difference of opinion among our various providers on the matter of
supplements DURING radiation treatment.
Think the difference of opinion results at least partially from the general statement often seen:
      "Radiation CAN/MAY result in short-term and long term side effects. While obtaining relief
       from these side effects obviously is desirable, it is very important for breast cancer patients
       undergoing radiation treatment to avoid taking supplements that will lessen the cytotoxic
       impact of radiation on breast cancer cells."
and how the physicians and cancer centers interpret this statement and what recommendations
they make.

If one has access to an oncology nutritionist at one's center, one might consider starting there
for the center's recommendations and then discuss with one's physicians.

Am looking forward to learning from any following posts.
We all know to discuss supplement use with our physicians especially during active treatment.

With caring and positive thoughts,
Grateful for today............Judy

Posted By: mindy555
Date Posted: May 22 2012 at 1:17pm

True. Just like while on chemo, certain institutions/providers may have strict provisions on supplementation during rads. A current supplement list would be reviewed and you'd adhere to that provider's protocol.

I too remember reading of a supplement that was oked by their doctor which helped during rads. Hopefully someone who knows will chime in. At least you can run it by your doctor.

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: 123Donna
Date Posted: May 22 2012 at 1:27pm

Mindy,

I believe Vitamin D is one supplement that improves radiation efficiency.

-------------
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: 123Donna
Date Posted: May 22 2012 at 1:43pm

As always, check with your rad onc first before taking any supplements.

http://www.ncbi.nlm.nih.gov/pubmed/21887591 - http://www.ncbi.nlm.nih.gov/pubmed/21887591

http://www.news.vcu.edu/news/Vitamin_D_compound_may_enhance_radiation_treatment_for_cancer - http://www.news.vcu.edu/news/Vitamin_D_compound_may_enhance_radiation_treatment_for_cancer

http://www.vitamindwiki.com/tiki-index.php?page_id=737 - http://www.vitamindwiki.com/tiki-index.php?page_id=737

-------------
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: mindy555
Date Posted: May 22 2012 at 2:16pm

Oh, yeah... that sounds right. Thanks Donna. I was able to use vitamin D and calcium on chemo too.

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: TriplePositiveGirl
Date Posted: May 22 2012 at 2:27pm

Hi Turtle,

I wanted to respond to your question about radiation. I had 35 rads after my surgery (a lumpectomy) - 5b which were dose dense. My personal experience was that you need to make sure you are moisturizing constantly - I used a combination of Miaderm and Aquaphor religiously. I also stopped wearing my bras (I am not that big busted anyhow), which definitely helped reduce any potential chaffing. I started wearing loose fitting t-shirts during this time. I did have a small issue with itching - like a sun burn itch. The doctor gave me a prescription for a stronger cortisone cream which worked well. Overall, my energy was not affected at all, and I never peeled or had any real problems with the radiation. MUCH MUCH easier than chemo - no comparison really. I also healed VERY quickly. (NOTE: I was a beach lifeguard for many years so possibly my skin was "sun-conditioned" to begin with, which may have helped). I do think if your skin type burns easily then you may really need to keep up the moisturizing more often. I do think Donna is right about the Vitamin D. Best Wishes,

Lisa

Posted By: snickers
Date Posted: May 22 2012 at 3:19pm

Tn Girl
I am also thinking about doing radiation even though I have had a mastectomy. What kind of rads did u have, length of treatment in weeks and what was the procedure leading up to the actual rads? Also, once started rads how long in and out of rad room?

thanks
Snickers

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: TriplePositiveGirl
Date Posted: May 22 2012 at 5:51pm

Hi Snickers!

I was diagnosed in 12/09 with TNBC - the tumor was 3.3cm, no lymph node involvement. I had a grade 2 tumor and I guess due to the size I am Stage 2A? I started neo-adj chemo (gemzar/carbo) in 2/10 and did 4 rounds to shrink the tumor (final size was 1.2cm when it came out), so I decided to have a lumpectomy after discussing this with my oncologist. I labored over the mast vs. lump, but according to what I had read, the odds of recurrence were only slightly more with a lumpectomy. The doctors concurred. I had my surgery in May 2010 and then had 2 more rounds of the chemo to complete the full course (i was not happy about that - they did not tell me it was 6 total cycles, but oh well what are you going to do anyhow). I started the radiation in Sept 2010 and it was 35 total treatments. They literally last about one minute - very quick, and painless. The only thing is it is daily, so it took 7 weeks to complete. It is like having a temp job (haha) for 10 minutes a day. The radiation did not bother me at all for the most part. I carried on my normal routine throughout. I have read that other women have had issues with the radiation treatments, so I know that everyone is different, but this was the easiest part for me personally. I recovered in just 2 weeks from it also. I was fortunate too - I never had any fatigue from the radiation. (fyi - i was 46 when going thru this).

Posted By: snickers
Date Posted: May 24 2012 at 12:37pm

Turtle, Mindy and Others
I promised I would get back with everyone that has given me great information on whether or not to have Radiation Therapy after have a mastectomy. I had a 1 hour consultation with my rad/onc and this is what he said:
1) yes, having Lymphatic Vascular Invasion (LVI) DOES play into your decision making. He put a call into the pathology lab to ascertain what extent mine was (the path report just said "present"). Mine was found to "moderate" which puts me into a grey area....sigh.....on whether to have radiation or not. He stated if mine was slight LVI, not worth the risk or if it was excessive, radiation would be worth the risk. He did said that having LVI in a moderate or high is like having one lymph node come back positive. He further stated that the medical community DOES NOT treat LVI as a major concern in their diagnosis because they (the physicians) do not have enough information yet at their disposal to use it in a evaluation/treatment plan. That is why having radiation after a mastectomy is so "grey." He stated that if I did NOT have LVI he would immediately tell me "NO" on radiation since I had no lymph nodes involved.
2) The long term risks could be .002% chance of acquiring another cancer, 16-20% of lymph edema , high chance within 6-8 months of my breast tissues tightening up and I would feel stiff in the chest area, but not enough to debilitate me, just would have to do some exercises and it might help the stiffness. Could scar a small portion of my upper lung area (again not debilitating would just show up on a lung x-ray) and chance of heart problems down the road. The heart problems is a very small chance UNLESS you already have heart problems then your risk rises drastically. Skin and bones could get brittle over a long period of time.
3)The short term risks are redness to chest area, blistering, soreness, etc.
Before I make up my mind, my rad/onc is going to contact a few experts in the area on mastectomy then radiation with LVI but 0 lymph node involvement and he will get back to me.
Turtle...thank you for those 3 links you sent me regarding this controversial issue. My rad/onc is going to contact all three of those hospitals and speak to one of the physicians.
If I decide to do radiation this is my treatment plan:
1)simulation test (they put dots on your chest and measure where the radiation will need to be targeted).
2)CT scan same day as simulation test
3)wait 1-2 weeks for the results to come back
4)start radiation-5 weeks-25 rads to:chest wall, supravascular area (above the clavicle) and the axilla area
Radiation will NOT stop systemic recurrence (meaning if the nasty little cells have already departed through the blood vessels, which is what chemo would treat and kill), but it would reduce my chance of loco-regional recurrence, meaning another tumor forming in the breast tissue area. Also, radiation would kill any cancer cells left behind after my mastectomy that the chemo did not take care of.
So.....I wanted to give everyone an update on my radiation therapy and I am waiting for my rad/onc to get back with me on other physicians renowned in the field of TNBC with LVI. I will update everyone as I get the information.
Ladies, I am not in anyway suggesting anyone go out and have radiation after having a mastectomy. It is a personal decision that one must make. When I mentioned to my rad/onc that I do not want to have a"cookie cutter" diagnose based on our sisters with ER+ or PR+, that TNBC must be treated as its own beast, he agreed. He said, ultimately, I must look at myself in the mirror at the end of the day when I make my decision and be comfortable with it. He said, if you feel you have done everything in your power to live a long/healthy life then LIVE YOUR LIFE and not worry.

Snickers

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: mindy555
Date Posted: May 24 2012 at 2:35pm

Excellent and thorough Snickers! Radiation is so controversial. Whatever you decide is tailored to YOUR needs.

Thanks for the update and good luck no matter what!

Mindy

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: Grateful for today
Date Posted: May 24 2012 at 4:48pm

Snickers and all,

Snickers, thank you for the great job you did on sharing the info from your rad onc consult.
So great you have such a dedicated and willing to consult radiation oncologist.

2 thoughts stated simply:   (am not asking you for answers.....giving as possible considerations)
Radiation to the axilla area: wondering if this means:
        full axillary radiation field verus right chest wall with tangents versus axillary apex.
Wondering if your rad onc also be consulting with the Chair of Rad. Onc (Jay R. Harris, MD) at DFCI
       where Nancy Lin Md and Eric Winer MD (both medical oncologists) are.

Same 2 thoughts with more detail:
Axilla area:
Radiation treatment plans are the realm of the radiation oncologists.
This is some very general information/questions to be aware of and ask about.
Does whether one had a SNB (sentinel node biopsy) versus an ALND (axillary node dissection make
    a difference in the amount of axilla in the radiation field?
Believe it is not either axilla or no axilla radiation .......believe there is something in between - the
     axillary apex and/or tangent technique.   It seems that the axillary apex and/or tangent technique
     would decrease(not eliminate) the risks of lymph edema and other skin/musculo-skeletal/lymphatic
     side effects/complications. Depending on one's clinical situation including what surgery one had
     and one's radiation oncologist treatment plan, the axillay apex-tangent field technique may or
     may not be an option.

If one of the Turtle's articles you referred to is the
http://www.ncbi.nlm.nih.gov/pubmed/22544643# - http://www.ncbi.nlm.nih.gov/pubmed/22544643#
Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network.
Lin NU, Vanderplas A, Hughes ME, Theriault RL, Edge SB, Wong YN, Blayney DW, Niland JC, Winer EP, Weeks JC.
Source:Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. nlin@partners.org.................
Have noticed from articles etc that NU Lin MD and EP Winer MD are medical oncologists at the DFCI.
From the DFCI website, Jay R. Harris MD is the Chief, Radiation Oncology at DFCI.
Thinking that your rad onc may be referred to Dr. Harris when he contacts DFCI or your rad onc may
already be planning to consult with Dr. Harris.
( Just a FYI: Dr. Harris is one of the 4 editors of one of the classic breast cancer textbooks. http://www.amazon.com/Diseases-Breast-Harris/dp/0781791170/ref=sr_1_1?s=books&ie=UTF8&qid=1337891307&sr=1-1 - http://www.amazon.com/Diseases-Breast-Harris/dp/0781791170/ref=sr_1_1?s=books&ie=UTF8&qid=1337891307&sr=1-1
..........looks like the textbook would be due for an updated edition.....book MAY be at a cancer
resource center. )

Have already said on an above post.......TNBC has so many grey areas.......each person has unique
variables in an individual situation.......after research and with physician consult(s), feel one makes
the best decision for them self in their unique, individual situation.

With caring and positive thoughts,
Grateful for today..............Judy

Posted By: snickers
Date Posted: May 24 2012 at 5:21pm

Grateful
You are correct, I cannot answer any of your questions. I do know that since my cancer was on my left side, radiation will be done there!!!! LOL
I received an email back today from my radiation onc and he emailed 6 radiation experts for their opinion so I probably will get 6 different answers!!!
Will keep everyone posted. I know NOTHING about radiation therapy as far as what is the most common used for a mastectomy with my 0 lymph node involvement and am just going to step back and see what the other 6 experts say and maybe they will even advise my radiation onc for the best procedure.

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: snickers
Date Posted: May 24 2012 at 5:24pm

Grateful
No, Turtles 3 links were regarding radiation and TNBC. All three stated that women with TNBC, 0 lymph node involvement, but have LVI (lymph vascular invasion) would be a candidate for radiation therapy after a mastectomy. You can find those 3 links further up on the forum page.

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: snickers
Date Posted: May 31 2012 at 10:06am

Ladies
I meet with my Radiation Oncologist, who then sent an email off to 5 well renowned rad oncs back east on their opinion of having radiation after a mastectomy with LVI (lymph vascular invasion), 0 lymph node involvement and this is what they said:
1 said no radiation
3 said yes on radiation chest wall only
1 said yes on radiation chest wall and lymph node area

I have decided to have radiation chest wall only, 25 rads, starting 3rd week June. I am meeting with my chemo onc prior to starting the simulation as I want to keep him in the discussion loop also as we are all part of the same team.

Thank you all for all your wonderful discussions on this controversial topic! Everyone must do what THEY feel is right for them and I feel this is the best thing for me due to having LVI.

Snickers

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: snickers
Date Posted: May 31 2012 at 10:11am

Ladies
Forgot to add the definition of my chest wall radiation treatment:
Chest wall is the chest wall from the lower clavicle to 1cm below the inferior breast fold and from the sternum to the mid-ancillary line. From a depth perspective this includes the skin to the internal chest wall.
This is the treatment my rad onc will be performing.

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: TriplePositiveGirl
Date Posted: May 31 2012 at 12:01pm

hey snickers,

sounds like you really thought this through and certainly got the necessary professional opinions to make an informed decision. personally, i would have chosen the radiation too. its an extra step worth taking that will increase your chances of no recurrences in the future! I hope your treatments go as smoothly as possible!

Lisa

Posted By: snickers
Date Posted: May 31 2012 at 12:09pm

Lisa
Thank you for the words of encouragement. For everyone reading this and all the other comments, please keep in mind that radiation does not stop systemic spread (meaning mets to visceral, that is what your chemo hopefully will do) but will greatly reduce LRR (local regional recurrence).
Thank you for everyone's words of encouragement and wisdom to assist me in making this decision. I would not have even thought about radiation without reading information in this forum about potential radiation recommended with LVI.
Lots of love to all of you TNBC sisters
Snickers

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: turtle
Date Posted: May 31 2012 at 12:16pm

Good luck snickers!

I'm right behind you literally and figuratively. I am scheduled to meet with my rad onc on June 11 to discuss my upcoming radiation treatment plan, just a bit after you begin.

Posted By: snickers
Date Posted: May 31 2012 at 12:21pm

Hi Turtle
I was JUST going to send you a message to let you know what my decision is. I feel so much better in making it since 4 out of 5 radiation/oncs said "YES!!" My simulation/CT test is June 12th and I tentatively start radiation on Monday, June 18th. Keep me posted on your radiation treatment and let me know if you are going to have the axilla area done. I am not since it was not recommended and I will then not be having lymphedema problems.

-------------
DX 10/31/11
6/13 lung/liver mets
9/13 NED lungs,liver met part.rem
5/4/13 NED lungs&liver
11/5/13 NED lungs..liver mets back
LOTS LVR METS had y90 liver trtmt mets contrld
1/3/14 num brain mets

Posted By: CiGi
Date Posted: May 31 2012 at 2:12pm

Good luck ladies with your radiation treatment. I really did not want to go through with it but since I had a lumpectomy I had to. A friend of a friend was going through it about a week before me and she was fine so I felt more at ease. I was a bit lucky where my skin did not really burn. I did use some rad skin cream from the cancer center that worked really well. I no longer have the cream, I gave it to my friend's grandfather who was going through radiation treatment. My rad onc was really amazed how little of burning I had. Since I still have my breast, it feels really strange after the radiation. I can't tell if it feels normal since it's not (to me). Onc says it's fine. I feel like it's been microwaved, kind of cooked. The skin is a little tan in color still and it's been over a year. When you go through the rad's you may feel a little tired a few weeks in, but nothing like chemo. When I went through with the treatments, I showered with very mild soap and did not rub the skin at all, wore a soft cotton bra, made sure nothing rubbed the skin and it wasn't bad at all. Good luck!!

-------------
Age 40, 4/28/10 lumpectomy (3 cm) TNBC Grade 3 Stage 2 0/3 nodes, TAC 6x 3 week cycles start 6/15 finish 9/27, 33 rounds rads 11/22. BRCA1 & 2 neg. Lymphedema rt hand 8/14. Joint pain Dec 2010.

Posted By: mindy555
Date Posted: May 31 2012 at 2:35pm

snickers.. I'm wishing you much luck. You really did your homework with some great doctors weighing-in during the process. You've been a glowing example of "what to do when on the fence". The more knowledge the better. Now you know without an ounce of doubt you've done everything in your power.

Speaking of doubt, I have NONE that you'll SAIL though rads without a hitch. Most women do. Thanks again for sharing your decision process here.

Take care and please check in from time to time to let us know you're doing well!

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: 123Donna
Date Posted: Jul 01 2012 at 1:02pm

bump

Posted By: mindy555
Date Posted: Jul 01 2012 at 3:52pm

Thanks for the bump Donna.

I'll add my final personal recommendation & decision for radiation post chemo & BMX- for what it's worth. After 3 consults - (2 radiology oncologists & my medical oncologist) it was agreed by these 3- no radiation. The benefits didn't prove to outweigh the risks. I have about a 6-8% risk of locoregional recurrence- and don't ask me how they arrived at that percentage. I never really got an answer. I take every number seriously since I was also in the 1% who's diagnosed with metaplastic features of the original mass.

Being in the "throw everything at it upfront" camp made the decision challenging. As many have seen here, even some of the best case scenarios in prognosis from a scientific standpoint can take a sharp turn in 'the other direction' within a few years.

The doctors I consulted do look at lymphovascular invasion... which was not present in my case. While it wasn't spoken, logic and some trial studies would seem to prove age should be factored in. I was told that even if I had LVI, the pCR trumps it. Candidly, because research and therapies are perpetually changing for TN, I'm not all that comfortable with rationale set forth by professional committees who decide risk/benefits. That info is already rather dated. When addressing this therapy in gray areas of women who've had mastectomies.. it's all too controversial for a right or wrong. Ultimately the patient decides. Then there's the issue of true studies for TN.. more complicated due to subtypes which aren't clumped in with all forms of BC. A rather big one I'd say.

Not quite a year ago I was diagnosed. Going into July now reminds me of a form of BC and a gene mutation I knew absolutely zilch about. I've recently discovered firsthand...many medical pros are still in the dark about tnbc. ALL brand-spankin' new news to them.

Thanks to Snickers, Turtle and others who've shared in-depth.

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: turtle
Date Posted: Jul 02 2012 at 4:05pm

Hello all,

I just started radiation today, and I think things will be fine. I am comfortable with my decision to do radiation after my mastectomy, due to the large number of risk factors that play into my situation:

1) premenopausal age of diagnosis (46)

2) hormone receptor negative (TNBC)

3) presence of lymphovascular invasion (even though I am node negative)

4) tumor size > 1 cm (mine was 2.5 cm)

I will be having just the breast area/chest wall irradiated, but due to my anatomy* (and because I pressed the issue, thanks Donna), this will include the internal mammary nodes. The supraclavicular nodes will not be done, nor the axillary nodes, as these were removed (just the axillary) during surgery. (**if the supraclavicular were treated now, they would not be able to be treated later if a met there should occur. Since there was no evidence that metastasis to these nodes was currently present, it was decided not to treat them).

I asked about a thyroid shield because some had brought it up, but was told that it wouldn't help. The reason is the type of radiation they give you is not the same as when you get a scan or an xray, where a shield can block the radiation. What I'll be getting is an intense, but focused beam, which could only really be blocked by many layers of concrete. Outside of the focused beam though, the radiation is thought to be minimal.

I am happy to post as a separate topic some of the research papers that were shared with me by my radiation oncologist which had to do with radiation therapy post-mastectomy in node-negative patients. It is treatment of this subset of patients that many radiation oncologists might disagree on as to whether to treat.

Incidentally Mindy, I would be inclined to agree that given your pCR, your decision not to do radiation is appropriate. As we've seen with Robin Roberts, all treatments carry their own risks, so it is important to weigh those on a case by case basis.

Best to all, and Happy July 4th!

*The internal mammary nodes are medially located--near the sternum, and deep in the chest wall. In my case, they were largely located within the field that was to be irradiated, so mapping the treatment area to include them entirely was not difficult, and did not involve treating tissue (i.e. the lungs) that was to be avoided. Thus, my particular anatomy allowed for this treatment option. But every body/shape is different, so this may not be true for everybody. Hope this clarification helps.

Posted By: TriplePositiveGirl
Date Posted: Jul 02 2012 at 4:13pm

Good luck Turtle. I think your decision is wise. I wish you smooth sailing with the radiation and a happy 4th!

Lisa

Posted By: Grateful for today
Date Posted: Jul 02 2012 at 6:19pm

Turtle,

Thank you for sharing not only your radiation decision but all the information and thinking that
went into it. More than appreciate the information sharing you did.

The best of good, gentle, cool and healthy skin/body wishes to you as you start radiation.

Yes, yes, yes! Whenever you get the time.
Would love you to post as a separate topic some of the research papers that were shared with you by your radiation oncologist which had to do with radiation therapy post-mastectomy in node-negative patients.
As you said: It is treatment of this subset of patients that many radiation oncologists might disagree on as to whether to treat.

With caring and positive thoughts,
Grateful for today..........Judy

==========================================================

Mindy,

Thank you for posting your radiation decision and the information you shared on your posts about this.
You really had a very challenging decision and what seems to me the grayest of gray situations.........
you researched and consulted ........you made the very BEST decision for you.
Would guess you are still smiling about the pCR.
Hope your recovery from the BSO surgery is progressing well.

With caring and positive thoughts,
Grateful for today.............Judy

Posted By: mindy555
Date Posted: Jul 03 2012 at 4:25am

Turtle..

You have my best wishes going forward. I know you'll do well. Like Donna, you've paid it forward by sharing compelling information for others (some on the fence) to dig deeper with their doctors by doing all homework to make the best individual decision with no regrets. Just as you've been thorough in making the best decision for you. Kudos.

I'd also like you to post your doctor's research papers on post mastectomy, node negative patients in the subset of patients for which radiology oncologists have differing opinions. This type of information can only be of value regardless of individual reasoning and ultimate decisions either way. Thanks for sharing, Turtle.

Judy,

Your thoughtful support, devotion to the forum backed by countless hours of your own research and the beautiful way you reach out to all TN sisters is consistently a blessing. We're all "grateful" FOR YOU and all you give of yourself here. Wishing YOU the very best, Judy!!!

How blessed we are to have the best support on the web!

-------------
Dx July 2011 56 yo
Stage I IDC,TN,Grade 3
Grew to Stage IIa- No ev of node involve- BRCA1+ chondroid metaplasia
Daughter also BRCA1+
Mass grew on Taxol
FEC 6x better
BMX 3/19/12 pCR NED
BSO 6/2012

Posted By: Boo
Date Posted: Jul 03 2012 at 9:53am

I could not agree more Mindy. Congratulations on your pCR. Thank you to Donna, DMwolf, Steve, and all the members who bring such insight, compassion, and terrific articles to this site. I search it daily for your postings. I have often been asked where I found material and I am happy to tell them there is a force of powerful women out there, thousands strong, looking for and sharing answers. With so much appreciation,

Anne

-------------
dx 12/2010 age 50 TNBC 12 X 9 cm tumor 1 node, 3 X FEC 9 X Doxitaxol with concurrent rads - 2X3 cm residual tumor 20/1/12 mets in lungs METMAB trial May 7 to Oct. 21, CHK1 /Gem trial 26/12/12 fails

Posted By: BethP
Date Posted: Jul 03 2012 at 3:06pm

I'm about to start radiation (next week), so I'm grateful for this information. Thank you for posting it.

-------------
Dx November 21, 2011: IDC, not staged; Gr. 2 nodes, largest 2.6 cm; Gr. 3 breast 1.2 cm; neo-adjuvant TAC; lump. + 16 nodes PCR

Posted By: 123Donna
Date Posted: Sep 27 2012 at 9:13pm

The Value of Ultrasound in Detecting Extra-Axillary Regional Node Involvement in Patients with Advanced Breast Cancer

http://theoncologist.alphamedpress.org/search?author1=Puneeth+Iyengar&sortspec=date&submit=Submit - Puneeth Iyengar http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-1 - ^{http://theoncologist.alphamedpress.org/search?author1=Eric+A.+Strom&sortspec=date&submit=Submit - Eric A. Strom http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-2 - ^{http://theoncologist.alphamedpress.org/search?author1=Yu-Jing+Zhang&sortspec=date&submit=Submit - Yu-Jing Zhang http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-4 - ^{http://theoncologist.alphamedpress.org/search?author1=Gary+J.+Whitman&sortspec=date&submit=Submit - Gary J. Whitman http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-3 - ^{http://theoncologist.alphamedpress.org/search?author1=Benjamin+D.+Smith&sortspec=date&submit=Submit - Benjamin D. Smith http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-2 - ^{http://theoncologist.alphamedpress.org/search?author1=Wendy+A.+Woodward&sortspec=date&submit=Submit - Wendy A. Woodward http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-2 - ^{http://theoncologist.alphamedpress.org/search?author1=Tse-Kuan+Yu&sortspec=date&submit=Submit - Tse-Kuan Yu http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-2 - ^{http://theoncologist.alphamedpress.org/search?author1=Thomas+A.+Buchholz&sortspec=date&submit=Submit - Thomas A. Buchholz http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract#aff-2 - ^{http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract# - + Author Affiliations
^aDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA;
^bDepartments of Radiation Oncology and
^cDiagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA;
^dDepartment of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
Correspondence: Puneeth Iyengar, M.D., Ph.D., Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5801 Forest Park Road, Dallas, Texas 75235, USA. Telephone: 214-645-8525; Fax: 214-645-7617; e-mail: mailto:puneeth.iyengar@utsouthwestern.edu - puneeth.iyengar@utsouthwestern.edu
Received April 16, 2012.
Accepted August 21, 2012.
Abstract}}}}}}}}

Assessment of the regional lymphatics is important for accurate staging and treatment of breast cancer patients. We sought to determine the role of regional ultrasound in providing clinically relevant information. We retrospectively analyzed data from patients who were treated curatively in 1996–2006 at The University of Texas MD Anderson Cancer Center for clinical stage III breast cancer. We compared differences in regional lymph node staging based on ultrasound versus mammography and physical examination in the 865 of 1,200 patients who had external-beam radiation as part of their treatment and regional ultrasound studies as part of their initial evaluation. Ultrasound uniquely identified additional lymph node involvement beyond the level I or II axilla in 37% of the patients (325 of 865), leading to a change in clinical nodal stage. Ninety-one percent of these abnormalities that could be biopsied (266 or 293) were confirmed to contain disease. The sites of additional regional nodal disease were: infraclavicular disease, 32% (275 of 865); supraclavicular disease, 16% (140 of 865); and internal mammary disease, 11% (98 of 865). All patients with involvement in the extra-axillary regional nodal basins received a radiation boost to the involved areas ≥10 Gy. Thus, over one third of patients with advanced breast cancer had their radiation plan altered by the ultrasound findings. Regional ultrasound evaluation in patients with advanced breast cancer commonly revealed abnormalities within and beyond the axilla, which changed the clinical stage of disease and the radiation treatment strategy. Therefore, regional ultrasound is beneficial in the initial staging evaluation for such patients.

http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract - http://theoncologist.alphamedpress.org/content/early/2012/09/13/theoncologist.2012-0170.abstract

Posted By: 123Donna
Date Posted: May 02 2014 at 6:37pm

bump for new members

-------------
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