Topic: Is There a Timeline within which Radiation needs to occur?

Forum: Radiation Therapy - Before, During, and After — What to expect from treatment and ways to cope with side effects.

Posted on: Oct 12, 2021 01:11PM

Posted on: Oct 12, 2021 01:11PM

macdebbie wrote:

I have a pretty large seroma in my breast near the tumor incision. I met with radiology Fri and she said it has to resolve before I have my "Planning Appt" as if they make all their marks and the seroma continues to get bigger or smaller, everything will be off.

I've had this at least for several weeks. I saw the PA at the breast surgeon's office last Mon. She was going to aspirate it but didn't have the right anesthetic (I can't have epinephrine). So she said if it got more painful to call and radiation would aspirate it.

I have no idea, obviously, to tell if this is getting bigger or shrinking. And the breast surgeon's PA said that they weren't going to monitor it, so how then does anyone know when it's "stable"?

I really don't want to have radiation until it's gone, even once it's "stable" as the radiation oncologist said that once you have radiation it "locks it in" and can never be aspirated and will never go down. She said she thought it best to let it resolve naturally rather than aspirating it due to the potential for infection, but I am worried about delaying the radiation beyond 8 weeks, which is what I was told was the max timeframe to start radiation.

The PA also said if it's aspirated it can just come back again. I really would like to see the breast surgeon, but I've been trying for 2 weeks and every time I call they say she's totally booked.

I called and made another appt for tomorrow so I can review with the PA what the radiation oncologist said and see what she says....

Anyone else go through this? I don't know if it's better to aspirate soon or wait a few weeks and see what happens. The radiation oncologist also said if it's aspirated, I have to wait a minimum of 1 week before I have the planning appt. Nov 9th will be 8 weeks since my surgery.

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Oct 13, 2021 02:58PM ratherbesailing wrote:

Macdebbie -

Glad you got the RO and BCS to discuss.

I would just caution you not to go by one isolated study. The Dana Farber study was in women over 65, and it's eleven years old. Another ACSO study published around the same time said radiation was effective in Stage I-II patients as far out as 20 weeks. We all need to be careful not to read just one or two articles and take it as gospel - our physicians should be up-to-date on all the research. That doesn't mean there is one "correct" answer, even for them - different studies have different underlying parameters and, often, different results. But still, they have a lot more information than we do, and are more adept at interpreting it.

Also, ask your RO for confirmation, but I believe in general they take "port" films once a week to check for any changes in body habitus that might affect the radiation field. So if your seroma changes, they will likely see it and be able to adjust. Again, I'm not a physician - check with your RO.

Sounds as though you're making progress!

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Oct 13, 2021 03:07PM macdebbie wrote:

Ratherbesailing, thx. Yeah, I know. It's hard. I just looked at my notes from the RO and she said they like to wait at least 4 weeks for a patient to heal, and she told me that if I have to go an extra month (so at 8 weeks) that would be OK. I seem to remember too that the MO said radiation ideally should happen between 4-8 weeks.

In any case, my RO office just called, and they said my BCS had cleared me for radiation, so I booked my planning appt. for 10/21. That gives me another week of compresses to try and resolve this a little more. I'll ask about the adjustment process, because I'd really like this to be gone before the actual radiation treatments, as I read that if a seroma is left, that it can become infected, and according to the RO once radiation starts it won't resolve.

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Oct 13, 2021 08:37PM ratherbesailing wrote:

That's terrific that you're cleared! I promise the stress of waiting and questions before treatment are almost always the worst part. Hope the seroma clears, and all goes smoothly for you.

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Oct 19, 2021 11:00PM - edited Oct 19, 2021 11:01PM by bcat40

Radiationdoes not “lock in" a seroma. I had a seroma show up on my planning CT. At the time it was not bothering me. RO went ahead with radiation. A week in it started bothering me. RO said I could have drainage, she would just have to take new films before my next treatment to make sure the radiation location did not change. They didn't get it all out the first time and I had another drainage with ultrasound guidance the day after radiation. They got it all out in needle aspiration with no problem. It was certainly liquid and came out.

Dx at 40. Did not tolerate hormone deprivation treatment. Dx 2/4/2020, LCIS/ILC, Right, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 3/25/2020 Lumpectomy; Lumpectomy (Right); Lymph node removal Radiation Therapy 6/2/2020 Whole breast: Breast
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Nov 21, 2021 03:50PM - edited Nov 21, 2021 03:52PM by too-ticky

I developed a fairly large seroma below my mastectomy scar, back in June. They tried to aspirate it shortly after surgery but couldn't. There are big treatment delays in my area so my radiotherapy didn't start till 5 months (yes, months!) after my surgery. Of course by that time the seroma was stable anyway and my Oncologist believed that was just the shape that I've healed in and didn't want to delay my treatment any further (which I was very pleased about!).

I've just completed my 15 radiotherapy sessions with bolus, so it's close to the skin's surface. So far the remaining seroma doesnt appear to have made any difference.

Dx 5/21/2021, ILC, Right, Grade 2, ER+/PR+, HER2-
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Nov 28, 2021 08:47PM loverofjesus wrote:

I just had DMX with expanders November 2. Had some issues with skin healing. Had another surgery for that. November 23 Most likely radiation would be put off till January sometime after my fills are finished and skin has healed. Which could be 10 to 12 weeks out. I had completely clean margins and no lymph nodes involved. I had chemo before surgery.

So my question is would the 10:12 weeks out be too long to be beneficial of radiation???

I have looked online but thought maybe you all could probably answer better as you have contact with your own drs.

Hormonal Therapy 5/21/2021 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 5/21/2021 Whole breast: Right breast, Lymph nodes, Chest wall Dx 5/22/2021, ILC, Right, 6cm+, Stage IIIA, Grade 1, ER+/PR+, HER2- Chemotherapy 6/15/2021 AC + T (Taxol) Surgery 11/2/2021 Mastectomy (Right): Simple; Prophylactic mastectomy (Left); Reconstruction (Left): Tissue Expander; Reconstruction (Right): Tissue Expander
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Nov 28, 2021 10:52PM pamep wrote:

LoverofJesus: My RO stated that radiation therapy should start by 12 weeks out from surgery. He was prompt to start my treatments to be within this timeline because my MO's referral was cutting it close. But, as you can see in my signature diagnosis, my BC is quite different than yours and that may play a role in professional timeline decisions. All in all, I am glad to have undergone radiation as a local recurrence preventative.

Be well.

Dx 7/26/2021, IDC, Right, 1cm, Stage IA, Grade 1, 0/4 nodes, ER+/PR+, HER2-, IHC Surgery 8/6/2021 Lumpectomy; Lumpectomy (Right); Lymph node removal Hormonal Therapy 10/15/2021 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 10/27/2021 Whole breast: Breast Hormonal Therapy 3/1/2022 Arimidex (anastrozole) Hormonal Therapy 3/1/2022 Arimidex (anastrozole)
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Aug 5, 2022 09:48AM parkstar wrote:

I am still waiting for my radiotherapy, I am well from lumpectomy and delays due to hospital wait lists. I was meant to get radiotherapy 6 to 8 weeks but only just got my planning CT scan date which will be week 11 and told won't get radiotherapy until week 13 or 14 and am concerned, delay could mean a less good outcome. Any advice?

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Aug 5, 2022 07:05PM quietgirl wrote:

I know this isn’t going to give you an exact answer but a Canadian group studied patients for 15 years post surgery/radiation and found no significant statistical difference between when radiation was started https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982229/ obviously from most perspective the sooner the better and statistics can get all wacko the more you look at them but considering recent COVID delayed in the last couple of years and such what might be ideal and what is reality can be two different things (added to that different countries seem to have guidelines the study I linked said something about in Italy they like to start before 15 weeks


I hope that helps a little

Surgery 2/7/2022 Lumpectomy (Right) Radiation Therapy 3/9/2022 Whole breast, Radiation boost: Right breast Hormonal Therapy 4/18/2022 Arimidex (anastrozole) Dx DCIS, Right, 3cm, Stage 0, Grade 2, ER+/PR+
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Aug 5, 2022 09:51PM carmstr835 wrote:

I had surgery March 2017, chemo May 2017, and radiation Sept 2017. The radiation was 6 months after my surgery. There were delays after surgery because my oncologist really didn’t want me to have chemo, but relented. They waited for the Ontario score and mamaprint even though I was HER2+. My cancer returned to my lungs almost 5 years to the day my first cancers were diagnosed. I had bilateral 2 primary breast cancers it was extra nodal and node involved on the right side, as well as HER2+. I wonder if I had treatment sooner would it still have returned as stage 4

Hormonal Therapy 3/22/2017 Arimidex (anastrozole) Surgery 3/27/2017 Lymph node removal; Lymph node removal (Right): Sentinel, Underarm/Axillary; Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): DIEP flap; Reconstruction (Right): DIEP flap Chemotherapy 5/17/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 6/27/2017 Perjeta (pertuzumab) Targeted Therapy 6/27/2017 Herceptin (trastuzumab) Chemotherapy 6/27/2017 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 9/11/2017 Breast, Lymph nodes, Chest wall Surgery 7/10/2018 Reconstruction (Left): DIEP flap; Reconstruction (Right): DIEP flap Surgery 10/16/2018 Reconstruction (Left): Fat grafting; Reconstruction (Right): Fat grafting Surgery 9/18/2019 Reconstruction (Left): Fat grafting; Reconstruction (Right): Fat grafting Surgery 3/8/2022 Chemotherapy 4/1/2022 Other Dx IDC, Both breasts, 1cm, Stage IIB, Grade 2, 2/17 nodes, ER+/PR-, HER2+, ISH, IHC Dx IDC, Stage IV, ER+/PR+, HER2+, IHC Targeted Therapy Nerlynx Surgery

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