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This question was answered on Thu 19, Jun 2008 02:32am by Dr Paul S, MD

IDC Breast Cancer 1/15 positive nodes - need for radiation?


    
Asked by natsfan (Female; 52; Dx with IDC breast cancer 12/31/07. 2 tumors in right breast - smaller is 1.2 cm, largest is 2.7, Grade 3. Had bilat mast with clean margins and no skin or chest wall involvement, 1/15 positive nodes, clean margins, no extranodal extensions. No vascular involvement found. Just finished 6 TAC chemotherapy yesterday, oncologist has indicated I will be on hormone therapy (undetermined which kind as yet as tests have not been done yet to determine whether chemopause is permanent - I was perimenopausal when dx).; Relevant drugs:n/a ) on Wed 18, Jun 2008 07:58pm

ER/PR+, HER/neu-. I am faced with making the decision now about whether to undergo radiation treatment. I have done extensive research in medical journals. It appears that I am in the low risk category and can reasonably make the decision to forgo radiation, but I am not a medical person so perhaps have not completely understood all I have read. What is your opinion? I have already met with one rad oncologist who said that his hospital now offers radiation to every node-positive patient, but was unable to back up with studies or evidence or even give me risk reduction numbers to show why it was appropriate in my case. I have a second consultation with a different radiation oncologist, but am trying to get as many qualified medical opinions as possible as to the level of risk reduction radiation might give me and whether it is appropriate in my case. Thank you!
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Answer by Dr Paul S, MD  on Thu 19, Jun 2008 02:32am:

Good day. Presently, there is emerging evidence that radiation for patients even with a single positive lymph node may be of some benefit, but this is still a matter of controversy and debate among cancer specialists. The degree of benefit that you may experience from radiation may be very small, and the side effects of radiation should play an important part in decision making (like pneumonitis, darkening of the skin, lymphedema, etc.). At the present, radiation is unequivocally recommended for patients with more than three lymph nodes, or those who have very large primary breast tumors (more than 5cm). The consultation with another radiation oncologist is welcome, as we may find a difference in attitudes between doctors. An aggressive doctor may recommend radiation outright, while a conservative doctor may not. Either way, there is no right or wrong answer. Regards and God bless.

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Clarification by natsfan on Thu 19, Jun 2008 12:45pm: 
Thank you so much!

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