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Any thoughts on Reirradiaton?
I am debating whether i should have a non skin sparing mastectomy / have only the affected skin area ( seems to be under control with tykerb and xeloda ) removed / or reirradiation. Here are my thoughts:
1. A non skin sparing mastectomy after the initial skin sparing mastectomy seems to be very drastic. I am afraid if skin mets comes back, the cons will overweigh pros.
2. Having a local excision is what i would go for. Since the tumor cells are in the lymphatic vessles anyways, a wide excision maybe over do. But isn't a non skin sparing mastectomy a standard treatment for IBC which also travels through lymphatic vessels?
3. I am not inclined to have the breast area reirradiated. According to my radiaologist, if the expander were not there, my local recurrence to skin would have been a chestwall recurrence. Since the tumor cells were found in the lymphatic vessels, he thinks my chestwall is also affected. (But there is no solid tumor identified on recent PET scan ).So when he treats me he would have to reirradiate the chestwall and decides what dosage i will get because it will affect my lungs.
My concern about reirradiation is that it will continue to damage my blood vessels in the breast area, lung and chestwall areas. I am afraid if there is another recurrence in my lungs, breast areas or chestwall, chemo drugs won't be effective for me because of insufficient blood supply in those areas. It means i will need radiation again. I can't imagine the damage going through radiation 3 times. I will probably die from severly damaged heart mussels and lungs.
Need your input on reirradiation.. Thanks !!!
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1/11 age 36 DX
ER/PR-, Her2 +
TCH*6, Herceptin
BMX with immediate recontruction 5/2011 Lattismus Flap- Dx stage 3c 10/23 nodes
9/11 Radiation
3/12 Local recurrence to skin stage IV
Whole body scan CLEAR
4/12 Tykerb & Xeolda Skin mets slowly regressing
8/12 PET & Brain CT Clear
5/13 Skin mets progressing
6/13 PET scan chestwall recurrence in contralateral anxillary,internal mammary and ipsilateral subpectoral nodes
6/13 kadcyla
10/13 whole body scan -clear NED. previously resolved skin rash gone but 3 new lesions. Biopsy confirmed for skin recurrence
11/13 to 02/14 tykerb & herceptin
02/14 add abraxane/gemzar, 2 weeks on 1 week off at reduced dose
05/14 whole body PET clear/ brain CT clear but skin mets are getting worse, ready for new chemo
05/14 navelbine perjeta herceptin
07/14 skin mets progressing red rash worse
08/14 wide local excision with diep flap to close wound. Final path shows 2 positive margins showing inflammatory carcinoma Going back to surgery in 2 weeks
09/01/14 resection- clear margins
3 weeks after 2nd surgery, a new nodular rash found near drain incision with 2 small red spots behind the chest wall biopsy on 10/1. Positive for breast cancer
Radiation 11/2014 with xeloda then weekly cisplatin
11/14 brain MRI clean
12/14 finished 33 radiations burnt and very painful. Bedridden for 1 week
12/14 t current Herceptin and perjeta only
02/15 rash on upper back right side skin mets radiation planned
02/15 staring electron radiation *35
Stopped at 30 due to severe skin burn, resumed 10 days later
05/15 red patches appeared in between previously radiated area, skin mets. Ct and brain Mri clear. Simulation planned, radiation to start after trip to Alaska.
05/24 new spot identified in scar line on previously radiated reconstructed breast- electron on both side chest wall area and scar line
07/15 multiple skin and lung recurrence begin halaven
11/15 cough much better but very tired on halaven and starting to see some new red skin blotches-suspicious
11/15 heading to China for immune therapy
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