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Topic: Skipping radiation if you are Her2+++ and over 70

Forum: HER2+ (Positive) Breast Cancer —

Testing, treatment, side effects, and more.

Posted on: Jul 12, 2020 07:19PM

Gundersk wrote:

I have just completed TCHP chemo followed by a lumpectomy. Total pathological response and no lymph node involvement. I am wondering if any of you Her2+ ladies have made a decision to skip radiation. Studies shared with me by SpecialK show that skipping rads in older women with smaller tumors had no impact on survival, but nothing is published yet for Her2+ women doing that. My tumor was stage 1, <1cm, grade 2. Any thoughts or experiences? My radonc gave me his blessing to skip, but he can't make a formal recommendation due to lack of data. Thanks!

Dx 10/2019, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 12/29/2019 Perjeta (pertuzumab) Targeted Therapy 12/29/2019 Herceptin (trastuzumab) Chemotherapy 12/30/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jul 13, 2020 11:25PM Wanda1978 wrote:

I skipped radiation. I just turned 60, completed TCHP chemo in January 2020 and lucked out with a PCR response. I discussed radiation with the radiation oncologist and decided not to do it. Between the COVID mess and the possible side effects, the risks outweighed the benefits or at least that's what I thought at the time. However, I do find myself second guessing my choice not to do it, but the RO thought I would do ok without it, so we'll see. I have/had triple positive and had a BMX

Dx 9/16/2019, DCIS/IDC, Right, 6cm+, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2+ Targeted Therapy 10/9/2019 Herceptin (trastuzumab) Chemotherapy 10/9/2019 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 10/9/2019 Perjeta (pertuzumab) Hormonal Therapy 4/8/2020 Arimidex (anastrozole)
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Jul 14, 2020 12:02PM Gundersk wrote:

Thanks for the reply, Wanda1978. I am vacillating so much due to my concern about side effects. Excuse my ignorance, but is a BMX a bilateral mastectomy? I only got a lumpectomy, although you and I have a very similar diagnosis.

Dx 10/2019, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 12/29/2019 Perjeta (pertuzumab) Targeted Therapy 12/29/2019 Herceptin (trastuzumab) Chemotherapy 12/30/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jul 14, 2020 01:52PM MinusTwo wrote:

I did not skip rads and I was 70. My MO felt that HER+ was a deal breaker if I didn't want to be back yet again at 80. On the other hand, my genes tend to long life and most don't die until mid-90. I wanted to give myself the best chance to make 96

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Jul 14, 2020 02:00PM Cowgirl13 wrote:

I was 63 when I had radiation and it was a very, very easy for me. I had a shorter protocol which was about 19 rounds. You might want to consider that there is this shorter protocol. I had no problems with my skin. If I were 70 and going through this I would definitely have radiation as HER2 is very aggressive. Good luck on your decision.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/18/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/23/2010 Arimidex (anastrozole)
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Jul 14, 2020 02:23PM MinusTwo wrote:

BTW - I had a very easy time too. I had 33 doses and drove myself to each one. Luckily never got burns. It takes longer to get there & get changed than for the zap. The only real side effect I had was fatigue. That is cumulative, but who knows how much of that was prior unrelieved fatigue from chemo.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Jul 14, 2020 10:25PM Gundersk wrote:

Thank you Minus Two and Cowgirls. I have decided to do it now based on the same thoughts you all expressed. I don't want to be in a recurrence situation where I am thinking wouda, coulda, shoulda... I fully understand it still can come back, but have decided to bite the bullet and do it. This forum is the best! Really, thanks so much.

Dx 10/2019, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 12/29/2019 Perjeta (pertuzumab) Targeted Therapy 12/29/2019 Herceptin (trastuzumab) Chemotherapy 12/30/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jul 15, 2020 12:55AM Cowgirl13 wrote:

So glad you have made your decision and are comfortable with it.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/18/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/23/2010 Arimidex (anastrozole)
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Jul 15, 2020 09:09AM SpecialK wrote:

gundersk - I am glad you are doing the rads too, I was treated a few years ago, but am now almost 64 and would do rads if needed. I have always been the personality type you describe, would have regrets if I didn't do all available treatment that I could. Ask your RO about the traditional course of rads and the shorter Canadian protocol, less days of treatment but the same number of grays administered - there may be age related pros and cons for both.

BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Jul 15, 2020 12:51PM Wanda1978 wrote:

Yes, glad that you have made the decision that is best for you. I did have a bilateral mastectomy and both my onc and rad onc concurred on no rads, and I agreed with their decision for my situation, but it's something I will always second guess.

Dx 9/16/2019, DCIS/IDC, Right, 6cm+, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2+ Targeted Therapy 10/9/2019 Herceptin (trastuzumab) Chemotherapy 10/9/2019 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 10/9/2019 Perjeta (pertuzumab) Hormonal Therapy 4/8/2020 Arimidex (anastrozole)
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Jul 15, 2020 03:28PM Gundersk wrote:

Hi SpecialK, thanks for the Canadian protocol information. I am scheduled for 20 sessions, but I don't know if that is traditional or short. I am doing the planning with him now, so I will ask. Thanks so much!

Dx 10/2019, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 12/29/2019 Perjeta (pertuzumab) Targeted Therapy 12/29/2019 Herceptin (trastuzumab) Chemotherapy 12/30/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jul 15, 2020 04:32PM SpecialK wrote:

gundersk - sounds like the short course (Canadian), maybe with a few boosts? It is commonly 3 weeks - 5 days a week, so 15 sessions, maybe with 5 boosts?

BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Jul 15, 2020 07:00PM Gundersk wrote:

Hmm, maybe. This is 20 sessions over 4 weeks. The last 4 sessions are partial breast radiation specifically to the tumor site. I will ask.

Dx 10/2019, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 12/29/2019 Perjeta (pertuzumab) Targeted Therapy 12/29/2019 Herceptin (trastuzumab) Chemotherapy 12/30/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jul 15, 2020 10:20PM - edited Jul 15, 2020 10:23PM by SpecialK

I believe those last ones would be the boosts. Here is a Komen blurb:


BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Jul 16, 2020 11:27AM Gundersk wrote:

Aha, got it, SpecialK Thanks!

Dx 10/2019, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2+ (FISH) Targeted Therapy 12/29/2019 Perjeta (pertuzumab) Targeted Therapy 12/29/2019 Herceptin (trastuzumab) Chemotherapy 12/30/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)

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