Mastectomy or Wide Excision for Contralateral Carcinoma

Five months after completion surgery for a Stage 11 ductal/lobular carcinoma, I have just been diagnosed with an agressive contralateral carcinoma (Bloom-Richardson 9/9, HR negative, HER-2/NEU positive, T2 at least, NX,MX).  I also have just completed proton radiation for a primary bone cancer and conventional radiation for the original breast cancer(75 Gys proton and 50 Gys photon/electron). With regard to other history, I had a TAH with BSO last year for a Stage 1 endometrial cancer (so four primaries in less than two years).

Medically, I could opt for either a mastectomy or breast conservation surgery. However,in making this decision, I have two questions regarding possible effects of radiation if I were to chose a WLE. Given that I will be having very aggresive (aggressive) chemo either way, would I be likely to tolerate having an additional 50 Gys or so of radiation? Would it be too much radiation?  Also, since I will surely have Adriamycin, should the possibility of radiation to the heart (this is the left breast)factor into my decision as well?

Thank you for your help.

[CCF-RN,MSN-rf]

Dear primariesfour:  The decision to do mastectomy or lumpectomy is largely a personal one, with a couple of exceptions.  Some of these are when the tumor is large and a good cosmetic result cannot be acheived, a person cannot complete radiation, or when there are medical reasons.  The most important consideration with respect to radiation is that it should not overlap a previously radiated area.  As you have been through radiation in the past, you are more familiar with your ability to tolerate the side effects.  It will, of course, prolong your treatment.  You should have a thorough discussion with your oncologist to discuss the pros and cons of all of your options as they pertain specifically to you.

[surgeon]

You indicated "primary" bone cancer. Do you really mean cancer that began in the bone, such as osteosarcoma, or cancer that got there from elsewhere, namely the breast?

[primariesfour]

The bone cancer is indeed a primary - a chordoma diagnosed via open biopsy this May.