breast cancer and radiation

[keekie]

I am 34 years old undergoing standard chemo treatment of dose dense A/C and then taxol and herceptin for stage 2b breast cancer(grade 3infiltrating, mixed duct and lobular features; 2.5 cm, ER/PR neg. her2 neu 3+ positive). I am post bilateral mastectomy. Pathology concluded 2/11 lymph nodes positive and w/ focal perinodal fat invasion. The radiology oncologist is reccommending radiation to chest wall, supraclavicular lymoph nodes, and inner mammory nodes. The axillary nodes will be excluded because this area was already disected and the risks (lymphedema) outweigh the benefits. I am a bit unsure of this as I had already had previous opinions from 2 other radiologist oncologist who would include the axillary nodes. Statistically speaking should I insist on having the axillary nodes radiated?

Thankyou for this service.

[CCF-RN,MSN-rf]

Dear Keekie:  There have now been several studies demonstrating that there is benefit to radiation therapy following mastectomy in high risk (node positive women).  This benefit applies both to local control of the disease and overall survival.  In these trials, the fields included the axilla.  Attached is a link from one of the studies for your review:  http://www.cancer.gov/clinicaltrials/results/postsurgical-radiation0106 .  Postmastectomy radiation treatment is usually recommended for larger tumors and those with four or more involved axillary lymph nodes. There is still some controversy among radiation oncologists on whether radiation should be given following mastectomy when 1-3 lymph nodes are involved. It is appropriate to seek an opinion from a radiation oncologist with expertise in breast cancer.