Help , I need your advice

[christie]

hi, i need your advice, i am so lost and i know that you all are the best people i can approach. I was diagnosed with Invasive Ductal Carcinoma, tumor was 2.5 cm in size, stage I, grade 2. ER-,PR-,Her2 positive (3+), I have had a mastectomy in the month of May 2008, Surgeon didnt remove any nodes, he says he did a axilla exploration and found it clear.(i dont understant what he means by that) . NO Mets.

I have finished 4 rounds of AC and 4 rounds of taxotere and Herceptin, have to do 5 more herceptin.

My Onc has told me that i need to start my radiation, the thing which is worrying me is that there is no linear accerlator machine here in Kenya ,only cobalt radiation is available

he has told me that it will be good for me, as its the right side and there is no breast, since its far from the heart i can go ahead with cobalt radiation.

Now i am really confused, should i go ahead with it?

please advice, i need to start it next week. I will really appreciate your advice. is cobalt radiation safe, what are its side effects?

love
christie

[Believe51]

My grandfather used 'COBALT THERAPY' in the late '60's and I have always found an interest in this while growing up. Canada was the primary source for treatment, well it was their claim fame as you will find out. Although I have not gathered information for some time now, the one thing I do know is that is has come a long way. It is not as strong as other forms of radiation but is efficient in its endeavors. If you need radiation and this is the only form available, it is worth the research....and the sincere consideration.

I hope that others have some links or knowledge to get you on your way. I pray that whatever choice you make that you will be happy and healthy with it. Do not know much about the side effects but they always appeared to be right up there with other forms of radiation.

Best wishes Christie, you are always just a thought away.>>Believe51

http://www.imaginis.com/radiotherapy/radio_how.asp

[Hopeful]

Christie,

Are there any alternatives available to you besides the Cobalt tx? For example, I am in the control arm of a study to compare partial breast irradiation with whole breast irradiation, which is the standard tx. The partial breast irradiation is at the discretion of the rads onc - either IMRT, brachytherapy or the mammosite balloon therapy. If you search on this board using any of these terms, you will find more information. Some feel that the mammosite therapy will be popular in places with limited access to conventional radiation therapy, as you describe.

I am thinking of you and wishing you well with your decision and treatment plan.

Hopeful

[christie]

hi,

i will talk to the radiologist and find out if anything is available other than cobalt, if not should i go ahead with it? please reply

[Jade]

The other incredibly knowledgeable women on this board will correct me if I'm wrong, but my understanding is that radiation is not necessarily needed if you've had a mastectomy, are Stage I and no positive nodes. What are they going to radiate? Did they not get clear margins when they did the mast? Hopefully our Her2 sisters will weigh in on this quickly as I know you need to make a decision. I'm all for treating this disease aggressively, but would not want you to endure additional treatment if it is unnecessary. Maybe you should get a second opinion? Good luck with all of this, a tough time in your life but the sun will shine again.

Love,
Jade

[BonnieR]

Dear Christie, Jade has made some very good points. A second opinion is always a good idea, I think. Especially if it helps clarify things for you. At the least, it sounds as though your onc needs to explain things more thoroughly.
Let us know what happens. Keep the faith.

[christie]

hi,

my reports says it was a tumor with deep resection margin. and since the nodes were not removed, my onc says its the best to do radiation. what do you all say? please guide me if cobalt radiation is safe. thanks a ton.

[Hopeful]

Christie,

I apologize for not reading your post closely enough to see that you had mastectomy. Here is a link to an abstract from the most recent San Antonio breast conference that concluded that there was some benefit for patients who had (like you) neoadjuvant chemotherapy and mastectomy followed by radiation: http://www.abstracts2view.com/sabcs/...08L_757&terms=

I found a research article for you which describes skin reactions to rads and other radiation induced damage to DNA: http://breast-cancer-research.com/content/7/5/r690 I think this will be relevant to you, as the description of the patients in the study states: "The patients were treated with postoperative radiation therapy after mastectomy (54 patients) or with breast-conserving therapy using a standardized 60Co technique (54 patients). The dose delivered was 50 Gy over a period of 5 weeks, in daily fractions of 2 Gy (25 fractions at 5 per week). External radiation was delivered by the cobalt unit in almost all of the patients (98%), and only 2% received irradiation from a Linac 6-MV x-ray linear accelerator."

I hope this has some information that can help you with your decision.

Hopeful

[Believe51]

Hello My Friend, sending you a gynormous hug today as you research and make decisions. Please know that whatever you may chose we will be right here for you. Breathe.>>Believe51

[Mary Jo]

Hi Christie....

So nice to "see" you here once again and glad you are almost finished with treatment. How did it all go?

I'm sorry I don't have advice for you but did want to offer you my support and prayers AND to say it was nice seeing your post.

Love and blessings...

Mary Jo

[christie]

hi,

thanks so much for all the love and support and concern, thanks for all the help. i look forward to your advice

[christie]

hi

i have to make a decision on Wednesday and most probably go ahead with cobalt radiation, if anyone in the board knows more about cobalt radiation , please do write in. i will appreciate it, is it safe? should i go ahead with it?

love
christie

[Lani]

J Clin Oncol. 2008 Mar 20;26(9):1419-26. Epub 2008 Feb 19. Links
Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group.

Kyndi M, Sørensen FB, Knudsen H, Overgaard M, Nielsen HM, Overgaard J; Danish Breast Cancer Cooperative Group.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Arhus Sygehus, Noerrebrogade 44, Building 5, 2, DK-8000 Aarhus C, Denmark. kyndi@oncology.dk
PURPOSE: To examine the importance of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and constructed subtypes in a large study randomly assigning patients to receive or not receive postmastectomy radiotherapy (PMRT). PATIENTS AND METHODS: The present analysis included 1,000 of the 3,083 high-risk breast cancer patients randomly assigned to PMRT in the Danish Breast Cancer Cooperative Group (DBCG) protocol 82 trials b and c. Tissue microarray sections were stained for ER, PgR, and HER-2. Median follow-up time for patients alive was 17 years. End points were locoregional recurrence as isolated first event, distant metastases, and overall survival. For statistical analyses four subgroups were constructed from hormonal receptors (Rec). Rec+ was defined as ER+ and/or PgR+. Rec-as both ER-and PgR-. The four subgroups were Rec+/HER-2-, Rec+/HER-2+, Rec-/HER-2-(triple negative), and Rec-/HER-2+. RESULTS: A significantly improved overall survival after PMRT was seen only among patients characterized by good prognostic markers such as hormonal receptor-positive and HER-2- patients (including the two Rec+ subtypes). No significant overall survival improvement after PMRT was found among patients with an a priori poor prognosis, the hormonal receptor-negative and HER-2+ patients, and in particular the Rec-/HER-2+ subtype. Furthermore, comparing hazard ratios and 95% CIs, significantly smaller improvements in locoregional recurrence control after PMRT were found for ER-and PgR-tumors compared with the ER+ and PgR+ tumors (P = .003 and .04, respectively), and for the triple-negative (P = .02), and the Rec-/HER-2+ subtypes (P = .003) compared with the Rec+/HER-2-subtype. CONCLUSION: Hormonal receptor status, HER-2, and the constructed subtypes may be predictive of locoregional recurrence and survival after postmastectomy radiotherapy.
PMID: 18285604

[Lani]

Gamma rays are another form of photons used in radiotherapy. Gamma rays are produced spontaneously as certain elements (such as radium, uranium, and cobalt 60), which release radiation as they decompose, or decay. Each element decays at a specific rate and gives off energy in the form of gamma rays and other particles. X-rays and gamma rays have the same effect on cancer cells.

Many of the original cobalt gamma ray systems have been replaced with linear accelerators. Cobalt systems can not deliver the higher power radiation that is possible with a linear accelerator, and thus may not be as effective at destroying cancerous tumor. Also, the radiation produced by a linear accelerator can be turned on and off, whereas the cobalt system consists of a radioactive source material which is always on.

Radium was used in various forms until the mid-1900s when cobalt and caesium units came into use. Medical linear accelerators have been used to as sources of radiation since the late 1940s.

http://books.google.com/books?id=hmb...esult#PPA56,M1
see pgs 51-6 in above link

helpful article as discusses history and pluses and minuses of cobalt therapy--on anniversary of 50 yrs of cancer treatment in India--date unknown: mohfw.nic.in/pg87to95.pdf

this implies the first machine was installed in India in 1957 and they are now manufacturing their own--has lots of technical info: http://www.barc.ernet.in/webpages/le...5/200502-2.pdf.

Cobalt radioisotopes in medicine

Cobalt-60 (Co-60 or 60Co) is a radioactive metal that is used in radiotherapy. It produces two gamma rays with energies of 1.17 MeV and 1.33 MeV. The 60Co source is about 2 cm in diameter and as a result produces a geometric penumbra, making the edge of the radiation field fuzzy. The metal has the unfortunate habit of producing a fine dust, causing problems with radiation protection. Cobalt-60 has a radioactive half-life of 5.27 years. This decrease in activity requires periodic replacement of the sources used in radiotherapy. This is one more reason why cobalt machines have been largely replaced by linear accelerators (linacs) in modern radiation therapy.

this implies the ability of cobalt 60 radiation therapy to give treatment exactly where you want it and minimize treatment where you don't want it is inferior to the abillity of LINAC systems which seems to be why Cobalt machines are considered obsolete in places other than Canada, India, China and the third world--this is just what I have gleaned from reviewing items on Google, There are fine people who are trying to modify it to deliver conformal and IMRT radiation therapy because their machines are limited by it and they seem to be trying to do the best with what they have.

So it seems it seems to be inferior...so the question is... if this is all I can get, should I get it at all.

That would depend on how close your deep margins were to the chest wall (ribs, intercostal muscles) and whether radioisotopes were utilized preop(doesn't sound like it) to determine whether inframammary nodes were sentinel nodes (these are not located in the armpit) By the way, you did not say which quadrant your tumor was in. Inframammary nodes are more often involved in tumors
located in inner quadrants I believe.

THE MOST PERTINENT ARTICLE I FOUND--but again, need to look at details regarding how close your posterior margins were ie, if less than 1-2 mm more worrisome.:

: J Clin Oncol. 2008 Mar 20;26(9):1419-26. Epub 2008 Feb 19. Links
Estrogen receptor, progesterone receptor, HER-2, and response to postmastectomy radiotherapy in high-risk breast cancer: the Danish Breast Cancer Cooperative Group.

Kyndi M, Sørensen FB, Knudsen H, Overgaard M, Nielsen HM, Overgaard J; Danish Breast Cancer Cooperative Group.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Arhus Sygehus, Noerrebrogade 44, Building 5, 2, DK-8000 Aarhus C, Denmark. kyndi@oncology.dk
PURPOSE: To examine the importance of estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and constructed subtypes in a large study randomly assigning patients to receive or not receive postmastectomy radiotherapy (PMRT). PATIENTS AND METHODS: The present analysis included 1,000 of the 3,083 high-risk breast cancer patients randomly assigned to PMRT in the Danish Breast Cancer Cooperative Group (DBCG) protocol 82 trials b and c. Tissue microarray sections were stained for ER, PgR, and HER-2. Median follow-up time for patients alive was 17 years. End points were locoregional recurrence as isolated first event, distant metastases, and overall survival. For statistical analyses four subgroups were constructed from hormonal receptors (Rec). Rec+ was defined as ER+ and/or PgR+. Rec-as both ER-and PgR-. The four subgroups were Rec+/HER-2-, Rec+/HER-2+, Rec-/HER-2-(triple negative), and Rec-/HER-2+. RESULTS: A significantly improved overall survival after PMRT was seen only among patients characterized by good prognostic markers such as hormonal receptor-positive and HER-2- patients (including the two Rec+ subtypes). No significant overall survival improvement after PMRT was found among patients with an a priori poor prognosis, the hormonal receptor-negative and HER-2+ patients, and in particular the Rec-/HER-2+ subtype. Furthermore, comparing hazard ratios and 95% CIs, significantly smaller improvements in locoregional recurrence control after PMRT were found for ER-and PgR-tumors compared with the ER+ and PgR+ tumors (P = .003 and .04, respectively), and for the triple-negative (P = .02), and the Rec-/HER-2+ subtypes (P = .003) compared with the Rec+/HER-2-subtype. CONCLUSION: Hormonal receptor status, HER-2, and the constructed subtypes may be predictive of locoregional recurrence and survival after postmastectomy radiotherapy.
The next article out of Germany shows they do not find PMRT mandatory except for those with large tumors and/or four or more positive lymph nodes. That is their current standard of care I think, but they did not delineate it by hormonal or her2 status (few articles do)



Strahlenther Onkol. 2008 Jul;184(7):347-53. Links
DEGRO practical guidelines for radiotherapy of breast cancer II. Postmastectomy radiotherapy, irradiation of regional lymphatics, and treatment of locally advanced disease.

Sautter-Bihl ML, Souchon R, Budach W, Sedlmayer F, Feyer P, Harms W, Haase W, Dunst J, Wenz F, Sauer R.
Municipal Hospital Karlsruhe, Karlsruhe, Germany. strahlentherapie@klinikum-karlsruhe.de
BACKGROUND AND PURPOSE: The aim of the present paper is to update the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society for Radiooncology (DEGRO). These recommendations were complementing the S3 guidelines of the German Cancer Society (DKG) elaborated in 2004. The present DEGRO recommendations are based on a revision of the DKG guidelines provided by an interdisciplinary panel and published in February 2008. METHODS: The DEGRO expert panel (authors of the present manuscript) performed a comprehensive survey of the literature. Data from lately published meta-analyses, recent randomized trials and guidelines of international breast cancer societies, yielding new aspects compared to 2006, provided the basis for defining recommendations referring to the criteria of evidence-based medicine. In addition to the more general statements of the DKG, this paper emphasizes specific radiooncologic issues relating to radiotherapy after mastectomy (PMRT), locally advanced disease, irradiation of the lymphatic pathways, and sequencing of local and systemic treatment. Technique, targeting, and dose are described in detail. RESULTS: PMRT significantly reduces local recurrence rates in patients with T3/T4 tumors and/or positive axillary lymph nodes (12.9% with and 40.6% without PMRT in patients with four or more positive nodes). The more local control is improved, the more substantially it translates into increased survival. In node-positive women the absolute reduction in 15-year breast cancer mortality is 5.4%. Data referring to the benefit of lymphatic irradiation are conflicting. However, radiotherapy of the supraclavicular area is recommended when four or more nodes are positive and otherwise considered individually. Evidence concerning timing and sequencing of local and systemic treatment is sparse; therefore, treatment decisions should depend on the dominating risk of recurrence. CONCLUSION: There is common consensus that PMRT is mandatory for patients with T3/T4 tumors and/or four or more positive axillary nodes and should be considered for patients with one to three involved nodes. Irradiation of the lymphatic pathways and the optimal time point for onset of radiotherapy are still under debate.
YOU DID NOT LIST YOUR PATHOLOGY ie, ductal vs lobular vs inflammatory but here is an article (obviously her2 status is not listed, but I have not found it listed in the articles I have reviewed so far)

Radiother Oncol. 2008 Oct 22. [Epub ahead of print] Links
The impact of postmastectomy radiotherapy on local control in patients with invasive lobular breast cancer.

Diepenmaat LA, Sangen MJ, Poll-Franse LV, Beek MW, Berlo CL, Luiten EJ, Nieuwenhuijzen GA, Voogd AC.
Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
PURPOSE: The aim of this population-based study was to examine the impact of postmastectomy radiotherapy on the risk of local recurrence in patients with invasive lobular breast cancer (ILC). METHODS: The population-based Eindhoven Cancer Registry was used to select all patients with ILC, who underwent mastectomy in five general hospitals in the southern part of the Netherlands between 1995 and 2002. Of the 499 patients 383 patients fulfilled the eligibility criteria. Of these patients, 170 (44.4%) had received postmastectomy radiotherapy. The median follow-up was 7.2 years. Fourteen patients (3.7%) were lost to follow-up. RESULTS: During follow-up 22 patients developed a local recurrence, of whom 4 had received postmastectomy radiotherapy. The 5-year actuarial risk of local recurrence was 2.1% for the patients with and 8.7% for the patients without postmastectomy radiotherapy. After adjustment for age at diagnosis, tumour stage and adjuvant systemic treatment, the patients who underwent postmastectomy radiotherapy were found to have a more than 3 times lower risk of local recurrence compared to the patients without (Hazard Ratio 0.30; 95% Confidence Interval: 0.10-0.89). CONCLUSION: Local control is excellent for patients with ILC who undergo postmastectomy radiotherapy and significantly better than for patients not receiving radiotherapy.

The letter to the editor, which cites the original article, discusses PMRT being necessary in those with 4 or more axillary nodes vs 1 or more nodes, but noone discusses it being necessary in those w no nodes:
http://jco.ascopubs.org/cgi/content/full/26/13/2075

Here is a very helpful article for you, although your tumor was not as big as these and so at even less risk:*****

: Cancer. 2008 Jul 1;113(1):38-47. Links
Postmastectomy radiation therapy for lymph node-negative, locally advanced breast cancer after modified radical mastectomy: analysis of the NCI Surveillance, Epidemiology, and End Results database.

Yu JB, Wilson LD, Dasgupta T, Castrucci WA, Weidhaas JB.
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06520, USA. james.b.yu@yale.edu
BACKGROUND: The role of postmastectomy radiotherapy (PMRT) for lymph node-negative locally advanced breast carcinoma (T3N0M0) after modified radical mastectomy (MRM) with regard to improvement in survival remains an area of controversy. METHODS: The 1973-2004 National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database was examined for patients with T3N0M0 ductal, lobular, or mixed ductal and lobular carcinoma of the breast who underwent MRM, treated from 1988-2003. Patients who were men, who had positive lymph nodes, who survived < or =6 months, for whom breast cancer was not the first malignancy, who had nonbeam radiation, intraoperative or preoperative radiation were excluded. The average treatment effect of PMRT on mortality was estimated with a propensity score case-matched analysis. RESULTS: In all, 1777 patients were identified; 568 (32%) patients received PMRT. Median tumor size was 6.3 cm. The median number of lymph nodes examined was 14 (range, 1-49). Propensity score matched case-control analysis showed no improvement in overall survival with the delivery of PMRT in this group. Older patients, patients with ER- disease (compared with ER+), and patients with high-grade tumors (compared with well differentiated) had increased mortality. CONCLUSIONS: The use of PMRT for T3N0M0 breast carcinoma after MRM is not associated with an increase in overall survival. It was not possible to analyze local control in this study given the limitations of the SEER database. The impact of potential improvement in local control as it relates to overall survival should be the subject of further investigation. (Copyright) 2008 American Cancer Society.

You also didn't state your age:
Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):98-106. Epub 2007 Nov 8. Links
Use of postmastectomy radiotherapy in older women.

Smith BD, Haffty BG, Smith GL, Hurria A, Buchholz TA, Gross CP.
Radiation Oncology Flight, Wilford Hall Medical Center, Lackland Air Force Base, TX, USA. benjamin.smith@lacland.af.mil
PURPOSE: Clinical trials and guidelines published between 1997 and 2001 concluded that postmastectomy radiotherapy (PMRT) improves overall survival for women with high-risk breast cancer. However, the effect of these findings on current practice is not known. Using the Surveillance, Epidemiology, and End Results-Medicare cohort, we sought to characterize the adoption of PMRT from 1992 to 2002 and identify risk factors for PMRT omission among high-risk older patients. METHODS AND MATERIALS: We identified 28,973 women aged > or =66 years who had been treated with mastectomy for invasive breast cancer between 1992 and 2002. Trends in the adoption of PMRT for low- (T1-T2N0), intermediate- (T1-T2N1), and high- (T3-T4 and/or N2-N3) risk patients were characterized using a Monte Carlo permutation algorithm. Multivariate logistic regression identified the risk factors for PMRT omission and calculated the adjusted use rates. RESULTS: Postmastectomy radiotherapy use increased gradually and consistently for low-risk (+2.16%/y) and intermediate-risk (+7.20%/y) patients throughout the study interval. In contrast, PMRT use for high-risk patients increased sharply between 1996 and 1997 (+30.99%/y), but subsequently stabilized. Between 1998 and 2002, only 53% of high-risk patients received PMRT. The risk factors for PMRT omission included advanced age, moderate to severe comorbidity, smaller tumor size, fewer positive lymph nodes, and geographic region, with adjusted use rates ranging from 63.5% in San Francisco to 44.9% in Connecticut. CONCLUSION: Among the high-risk patients, PMRT use increased sharply in 1997 after the initial clinical trial publication. Despite subsequent guidelines recommending the use of PMRT, no further increase in PMRT use has occurred, and nearly 50% of high-risk patients still do not receive PMRT.
J BUON. 2007 Apr-Jun;12(2):215-20.Links
Postmastectomy radiotherapy in intermediate risk stage I-II breast cancer patients.

Mladenovic J, Susnjar S, Gavrilovic D, Borojevic N.
Department of Radiotherapy, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia. mladenovicj@ncrc.ac.yu
PURPOSE: To evaluate the correlation of postmastectomy radiotherapy (PMRT) with local relapse rate, disease-free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients at intermediate risk for locoregional relapse (stage I-II with either 1-3 positive axillary nodes, or node-negative grade III BC) treated with radical mastectomy. PATIENTS AND METHODS: We evaluated 482 stage I-II BC patients, with either node-negative grade 3 tumors or with 1-3 positive nodes irrespective of tumor grade, treated with radical mastectomy at our Institute from 1986 to 1994. After mastectomy they received either adjuvant CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy (N=172), or adjuvant endocrine therapy (N=310). Postoperative radiotherapy (RT group) to the regional lymph nodes with tumor dose (TD) 48 Gy in 22 fractions was delivered to 199 patients. RESULTS: After a median follow-up of 79.5 months, no difference in relapse rate between the two groups was seen (30.6% in the RT group vs. 36.7% in the no RT group; x(2), p=0.1). Local recurrence rate occurring alone or with distant metastases was 4.52% in the RT group vs. 7.77% in the no RT group (x(2), p=0.1). However, local recurrence rate alone was significantly higher in the RT group compared to the no RT group (2.01 vs. 6.01%, x(2), p=0.041). In premenopausal patients local relapses occurred in 3.2% of patients with postoperative RT and in 8.2% in patients without RT (Fisher's exact test, p=0.48). Non significant difference was registered in postmenopausal patients with (4.76%) or without RT (6.58%). Ten-year DFS and OS were 53.5% and 68.7% in the RT group vs. 52.9% and 75.2% in the no RT group (non significant difference). CONCLUSION: Our results did not show that PMRT significantly influences the incidence of disease relapse, DFS and OS in stage I-II BC patients with intermediate risk for disease relapse. However, it seems that PMRT might influence the occurrence of locoregional recurrence in these patients.
PMID: 17600875

[Lani]

omy radiation therapy WOULD BE HELPFUL--

Int J Radiat Oncol Biol Phys. 2007 Jul 15;68(4):1024-9. Epub 2007 Mar 29. Links
Can a subgroup of node-negative breast carcinoma patients with T1-2 tumor who may benefit from postmastectomy radiotherapy be identified?

Yildirim E, Berberoglu U.
Department of Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
PURPOSE: To determine a subgroup of T1-2N0 breast carcinoma patients at high risk for local recurrence. METHODS AND MATERIALS: In this retrospective study, univariate and multivariate prognostic factor analyses for local recurrence and distant recurrence were carried out in 502 patients. RESULTS: During the median observation time of 77 months (range, 24-191 months), 14 patients (2.8%) had local recurrence and 55 (11.0%) had distant recurrence. Tumor size (continuous, p = 0.03; hazard ratio [HR] 1.2; 95% confidence interval [CI], 1.1-1.7), grade (p = 0.01; HR, 2.4; 95% CI, 1.2-5.0), lymphatic vascular invasion (LVI) (p = 0.01; HR, 10.0; 95% CI, 2.4-17.3), estrogen receptor status (p = 0.01; HR, 6.3; 95% CI, 2.0-23.0) and cErbB2 status (p = 0.01; HR, 10.0; 95% CI 1.8-87.5) were strongly associated with distant recurrence. Tumor size (< or =2 cm vs. >2 cm; p = 0.05; HR, 5.4; 95% CI, 1.2-28.0) and LVI (p = 0.004; HR, 9.0; 95% CI, 2.0-41.0) in patients aged < or =40 years, and tumor size (< or =3 cm vs. >3 cm; p = 0.05; HR 8.6; 95% CI 1.3-75.0), LVI (p = 0.007; HR, 18.0; 95% CI, 2.1-153.0), and grade (p = 0.05; HR, 7.0; 95% CI, 1.2-63.0) in patients aged >40 years were the most important predictive factors for local recurrence. CONCLUSIONS: Among breast carcinoma patients, young patients with tumor size >2 cm and LVI and older patients with tumor size >3 cm, LVI, and high-grade tumor had a high risk of local recurrence.
PMID: 17398017

[Lani]

with info on radiation therapy, treatment choices, etc in Kenya?\

Here is the website:

http://www.kenyabreast.org/

Perhaps you can find out if anyone is using a LINAC machine, rather than a Cobalt machine, and see if you can find someone for a second opinion as to whether you need the treatment at all.

Best of luck!

[christie]

hi lani,

thanks a lot for the information, that was helpful.

[christie]

Dear Lani,

I am sending you my full report, right from biopsy to the post operative report, i hope you will get all details as to how deep was the margin and how big was the tumor and other details.

thanks a lot, will wait for your response

love
christie
My biopsy report before surgery said::::

FNA right breast-

Microscopy: Moderate cellularity consisting of malignant ductal cells, lying singly and in groups.
The cells nuclei are enlarged, hyperchromatic with prominent nucleoli. Pleomorphism is seen.
Adipose tissue and stromal element are also seen.

Diagnosis: Features are consistent with those of ductal carcinoma – right breast

My mastectomy specimen report said: (pathology)

Gross: cut section shows a white tumour 3cm maximum diameter and 0.7 cm from deep resection margin. No lymph nodes are felt.

Microscopy: sections show breast tissue involved by an invasive tumour composed of ductal cells that are moderately pleomorphic,
Show few mitoses and moderate tubule formation. The tumour has provoked an intense desmoplastic reaction.
The tumour shows intraductal tumour of both comedo and solid styles and shows lymphatic permeation.
Tumour extends close to the deep resection margin.
No background breast disease is seen

Diagnosis: Invasive Ductal carcinoma(NOS) grade I,


test for ER,PR and Her2 --

Addendum: Immunoperoxidase staining was performed with adequate controls and the following staining reactions obtained:

Oestrogen receptor staining _ Intensity (0)
Distribution (0)
Score (0) negative

Progesterone receptor staining - negative

HER 2 score(+3) - positive


SUMMARY : Immunihistochemistry shows this tumour to be ER (-ve), PR(-ve), her2 (+ve)

[christie]

lani,
i am 38 years old.

[Lani]

to figure that out you divide your breast into left and right halves by bisecting the breast through the nipple and decide if the tumor lay toward the other breast (inner) vs away from the other beast (outer)