the order of treatment

biopsy from first surgery reported TN this week,  we have a team together another surgery is planned then a six week hiatus after which the team recommends radiation then chemo.  Monday an MRI is scheduled, tuesday we meet the oncologist and radiation oncologist for the first time. Question... does the order of the treatment make any difference.  for instance my husband and I read a result on web that having chemo before the operation met with successful results.  Has anyone else heard this ????
or have thoughts on the order or treatment...making any significant difference

thanks for info
yes they have planned to do surgery, radiation, then chemo

but have seen some NT studies where they do chemo before surgery


 "Because patients with TNBC often are treated with an anthracycline regimen and have poorer prognosis and overall survival, research is needed to evaluate new, more effective treatments. Trials are researching the use of bevacizumab before surgery, newer agents that interfere with certain cell signaling pathways, and platinum compounds (Reynolds, 2007). The Triple Negative Trial, a clinical trial directed at women with TNBC, is evaluating carboplatin and docetaxel in the United Kingdom (National Institutes of Health, 2008a). Ongoing chemotherapy trials, using agents such as gemcitabine and oxaliplatin; abraxane, bevacizumab, and carboplatin; weekly paclitaxel and carboplatin; cisplatin; gemzar and cisplatin; and erlotinib, are being conducted (National Institutes of Health, 2008b)."


we will know more by the end of the week when they STAGE the cancer
and meet with oncologist tuesday for the first time


Edited by puppi - Aug 23 2009 at 12:54pm

They usually do radiation after chemotherapy but I have read that there is not a significant different in prognosis from doing it the other way. Not sure why your oncologist is recommending you do radiation first. Ask them.

Roxie,

I also go to MDAnderson and my Onc had me do Taxol x 12 ( 1 x weekly) , then FAC x 4 ( 1 x every 3 weeks) PRIOR to surgery.  This is called neoadjuvant therapy.  This method allows them to determine if the chemo is

Dear Puppi,

The most common treatment plan is surgery followed by chemo followed by radiation. I've not heard of radiation before chemo (except in clinical trials; but does not mean it is not done) nor of radiation before surgery in early stage breast cancers.

But yes, chemo before surgery is done quite often. It is called neoadjuvant chemotherapy. It helps in some ways:

1. You can observe the tumor shrink indicating the efficacy of the chemo. The jury is still out on whether the shrinkage raises false hope or is really indicative of long term prognosis.

2. It increases the chances that lumpectomy would become viable if it was initially not viable due to tumor size.

3. In a certain % of cases, the tumor gets completely killed by chemo. This is called pCR or Pathologic Complete Response. However, surgery is still needed to remove the tissue and margins from where the tumor used to be.

4. Peace of mind that metastatic disease, the real danger, is being addressed first.

It also has some down sides:

1. When the chemo is done, the tumor cells on the periphery die in patches so when the tumor is removed, it may become very hard for the pathologist to be sure that the margins are negative even if they are indicated to be negative.

2. The body takes longer to recover from chemo to be ready for surgery than the other way.

3. I'm not sure that Dose Dense chemo has been studied in neo setting, so the chemo may take longer.

4. Biopsy results and staging can become skewed if the biopsy is done after chemo. This is why sometimes they still do the sentinel node biopsy upfront before doing the chemo. This means you will need surgery 3 times, a tumor biopsy, sentinel node biopsy (and axillary node dissection if needed) and lumpectomy. If surgery is done before chemo, you go into OR 2 times, once for tumor biopsy and second time for lumpectomy sentinel node biopsy (and axillary node dissection if needed).

5. There is a belief that Taxane based regimens in Neo setting actually lead to breakaway cancer cells to enter bloodstream and increase chances of future more vengeaful metastatis.

Hope this helps.

Regards, Unklez

Puppi,