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Topic: Radiation after DMX?

Forum: Radiation Therapy - Before, During, and After —

What to expect from treatment and ways to cope with side effects.

Posted on: Aug 16, 2021 06:30PM

Taralynn wrote:

hi all! I have an appt with my RO next week but I’m curious to ask here. When I saw my RO prior to my DMX, it was assumed I would have radiation because they thought my tumor was larger than 5cm. After all was said and done it was actually 3cm. I did have 2 positive nodes (one macro, one micro) so I’m assuming that’s why they’re wanting to continue with radiation.

In reading I see that it says “most” people who get a mastectomy don’t need radiation unless the tumor is above 5cm, margins weren’t clear (mine were) and a few other things that didn’t apply to me. It also said sometimes with positive nodes you’ll get radiation.

So I guess my question is, who had radiation after a mastectomy? And what was the reason? If just positive nodes, do they only radiate the axilla? Thank you all!

Mom of 3, Diagnosed at 39. Dx 10/15/2020, IDC, Right, 3cm, Stage IB, Grade 2, 2/8 nodes, ER+/PR+, HER2- Surgery 12/15/2020 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 3/30/2021 AC + T (Taxol)
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Aug 16, 2021 07:59PM OCDAmy wrote:

I had chemo and then rads after BMX. I had a large tumor but clear margins. I was told rads was because I had 2 positive nodes. Best of luck to you.

Dx 2/2017, IDC, Left, 4cm, Stage IIB, Grade 2, 2/13 nodes, ER+/PR+, HER2- Surgery 11/14/2018 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting, Silicone implant Surgery Lymph node removal; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Arimidex (anastrozole) Surgery Reconstruction (left): DIEP flap Radiation Therapy Whole-breast
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Aug 16, 2021 08:14PM Redkitty815 wrote:

I also had radiation after a double mastectomy. It was because I had a larger tumor (3 cm) and one node with a macromet and so I am considered high risk. They did my breast, axilla and chest wall.

Dx 11/26/2019, IDC, Left, 3cm, Stage IIB, Grade 3, 1/12 nodes, ER+/PR+, HER2+ (FISH) Chemotherapy 12/19/2019 AC + T (Taxol) Targeted Therapy 7/12/2020 Herceptin (trastuzumab) Chemotherapy 7/12/2020 Navelbine (vinorelbine) Surgery Lymph node removal; Mastectomy; Reconstruction (left); Reconstruction (right)
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Aug 17, 2021 06:03AM barbojoy wrote:

@Taralynn. I had DMX & tumor was 1.9 CM with 1/1 lymph node positive + DCIS. Clear margins and no lymphovascular space invaded. I was informed that after chemo I too will have radiation. I do not want radiation. MO said there is zero chance that requirement will change post-chemo. I (like you) am researching and trying to understand why it is necessary. If you learn anything more, please share it here. I will as well. My chemo regimen will be 18 weeks, so it will be a while before I meet w/ radiation oncologist directly.

Dx 6/15/2021, DCIS, Left, 6cm+, Stage 0, Grade 2 Dx 6/15/2021, IDC/Paget's, Left, 1cm, Stage IIA, Grade 3, 1/1 nodes, ER+/PR-, HER2+ (FISH) Surgery 7/27/2021 Mastectomy: Left; Prophylactic mastectomy: Right
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Aug 17, 2021 06:39AM ThreeTree wrote:

Taralynn - I only had a single mastectomy, but had proton radiation after. My tumor was about 5.5-6 cm (I never quite got the exact size, as different scans/pathology said somewhat different things before and after neoadjuvant chemo. ER/PR+, HER-, grade 2, IDC It had attached to the chest wall and one of the margins wasn't quite clear. I only had sentinel node biopsy and that was clear after neoadjuvant chemo. Prior to neoadjuvant chemo they had thought there was no node involvement, but since no one knew for absolute certain about the nodes, they too were included in the radiation. I had radiation to the axilla, chest wall, and clavicle area - pretty standard for my situation from what I understand.

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Aug 17, 2021 08:00AM - edited Aug 17, 2021 08:18AM by muska

I had radiation even though my tumors were tiny: 0.3 and 0.9 cm. Clean margins but the tumors were close to the chest wall. I also had several lymph nodes with cancer, so radiation targeted sub- and supra- clavicular area in addition to axilla.

Edited to add: simply put, the radiation field included more than just breast.

Dx at 54 Dx 5/9/2013, DCIS/IDC, Right, <1cm, Stage IIIA, Grade 3, 7/11 nodes, ER+/PR+, HER2- (FISH) Dx 6/13/2013, LCIS, Both breasts Surgery 6/13/2013 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 7/25/2013 AC + T (Taxol) Surgery 2/20/2014 Reconstruction (left); Reconstruction (right) Hormonal Therapy 3/12/2014 Arimidex (anastrozole) Radiation Therapy 3/23/2014 Breast, Lymph nodes, Bone
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Aug 17, 2021 08:23AM RatherBeSailing wrote:

Most recent NCCN guidelines below.

Taralynn, I think you're probably correct in thinking it's the positive nodes making them recommend radiation. Also likely your young age.

As you can see, they usually radiate the axilla, supraclavicular and internal mammary nodes. Another portion of the guidelines says, if radiating the internal mammary nodes they need to be careful of heart and lung constraints.

Best of luck to you.


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Aug 18, 2021 07:20AM Taralynn wrote:

thank you all for your insight!

@ratherbesailing - great info, thank you!

@barbojoy - best of luck with your chemo. I just finished a week ago :)

Mom of 3, Diagnosed at 39. Dx 10/15/2020, IDC, Right, 3cm, Stage IB, Grade 2, 2/8 nodes, ER+/PR+, HER2- Surgery 12/15/2020 Lymph node removal: Right, Sentinel; Mastectomy: Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 3/30/2021 AC + T (Taxol)

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