Radiation therapy to lymp nodes under the arm after breast cancer

[ConcernedInGeorgia]

I had a lumpectomy to my left breast along with sentinal node removal.  Two sentinal nodes were removed and were positive.  10 more lymp notes were removed and two were positive.  In one of the nodes the tumor had grown through the capsule of the node. I am Her2 negative, estrogen positive.  

I have had a consultation with two Radiation Oncologist and had two different courses of treatment suggested.  One of the doctors suggested radiation to include the lymp nodes under the arm.  He told me that it would increase the potential of developing lympodema by 3% but would reduce the chance of a reoccurance in the lymp nodes by 10%.  He told me that this is a treatment that is under dispute and many doctors do not do it. The other doctor did not recommend this treatment.  

I am confused.  I have completed chemo therapy and am willing to do any treatment that will reduce my chances of reoccurrance.  However, I do not want to do an unnecessary treatment or a treatment that has not been proven or will leave me with a quality of life altering problem like lympodema.  Could you please offer any information that might help me understand this better?  Thanks!

[CCF-RN-JS]

Dear ConcernedinGeorgia, I received some additional information from one of our Radiation Oncologists that may also be helpful to you.  

Treatment of the axillary lymph nodes was standard-of-care for women with early-stage breast cancer up until about a decade ago.  At that point it was recognized as one of the two major contributors to lymphedema, the other being full axillary dissection.  At this time the use of a "posterior axillary boost" to specifically target axillary nodes is only standard for women who have an inadequate nodal sampling (too few nodes examined: a number that is controversial and technique dependent), gross residual disease in the axilla after surgery, and management of inflammatory breast cancer.

Some radiation oncologists would add axillary treatment if a large percentage of nodes were involved (e.g., 23 of 24 nodes positive).
Extracapsular extension is only an indication for axillary treatment if the extension is obvious in the gross pathology specimen as opposed to a microscopic finding.

Ten nodes is an adequate sampling by all standards.  Treatment of the supraclavicular nodes would be routine for a woman with more than three nodes positive.  In this situation I would recommend "three-field" treatment of the breast and supraclavicular nodes, but would only favor axillary treatment, "four-field," if the pathologist or surgeon confirmed the presence of "gross" extracapsular extension into the surrounding tissues.

[abbe_jo]

I had a lumpectomy of the right breast and have lympodema in my right arm and breast and under the arm also. I wear compression sleeve and also a compression bra, with little or no relief. i have also triend lympodema therapy,with little help. where to i go from here will lyposuction help?  someone told me accupunture helps,does it?

[SimplyStar]

don't want to rain on your parade  but the first post was back in 2003  and also this is the OVCA forum, not too many of us deal with breast cancer.

[abbe_jo]

My question was about lymphydema not brest cancer. i was inquiring  because several posts talked about it and i need help.

[Kimchi]

There is no harm in doing accupuncuture, may work for you.  Also consider refexology massages..I slipped a few weeks ago and pulled just about every muscle/ligament in my left arm which I used to brase myself...Went 2 days later for a reflexology session which helped relax and release  pain and muscles from my shoulder down to my finger tip.  Developed a "Frozen shoulder" and have to do physical therapy on my own to regain the movemet but don't think it helps much.  Went for a massage again today, and now can raise my arm up to my ear.  Not knowing much about lympectomy, but do they cut the muscles or ligaments? if so, than it could be that you need to restrengthen them in that arm...