HER2 Support Group Forums - Devasted. Bad news.

Mischka--my previous two posts succumbed to your panic and did not follow my own long-standing rule as to how to respond to bad news of one's one or others

Rather than get scared and just ask for others' experience on an internet support site (very important and incredibly helpful though it might be), benefit from the worldwide experience as described by those who best can document and evaluate it objectively(with MRI scans of response to treatment, all the relevant test results(FISH levels, size of lesions, doses of chemo, rads etc) ie, using the national librayr of medicine via PUBmed which covers the entire world's literature--not just that of the English speaking world

I seemed to have remembered that having solitary sternal mets carried a rather more favorable prognosis so....

I put sternum metastasis breast cancer into pubmed and...voila... even without using my ability to get full articles found the following, including several articles which are free access in full

Here they are and they sound good!(even the rather extensive one's which required extensive surgery and even the cautionary one was cautionary because the patient had other metastases besides the sternal one which changed the picture! Remember for every very bad case which whose successful treatment is published/publishable there are probably hundreds or thousands of much less remarkable cases that went smoothly, were not considered remarkeable and were not published:

J Chemother. 2011 Feb;23(1):49-52.
Successful multimodal treatment of a breast cancer patient with a recurrence invading the chest wall.
Corrado G, di Stefano A, Salutari V, Piraino A, Margaritora S, Lucidi A, Scambia G, Ferrandina G.
Source
Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Campobasso, Italy. giacomo.corrado@alice.it
Abstract
We describe successful operative management of a solitary breast cancer metastasis in the chest wall after complete response with concomitant non-pegylated liposomal doxorubicin (NPLD) and docetaxel followed by sternal rib resection with prosthetic reconstruction. We report a case of a 41-year-old woman who had a breast cancer recurrence infiltrating neighboring osteo-cartilage of the left sternal body, the cartilaginous portion of the third and fourth ipsilateral ribs and was inseparable from the rear side pectoral reaching deep into contiguity with the pericardium. After 6 cycles of chemotherapy with NPLD plus docetaxel, sternal rib resection with prosthetic reconstruction was performed. Histological examination did not show any evidence of residual tumor. At 9 months of follow-up, the patient appears free of disease. Our case demonstrates that a multimodal approach in patients with chest wall recurrence of breast cancer without distant metastasis, may be safe and effective for maintaining a good quality of life.
PMID: 21482496

Ann Thorac Surg. 2011 Feb;91(2):584-6.
Sternal metastasis of breast cancer: ex vivo hypothermia and reimplantation.
Rosenberg M, Castagno A, Nadal J, Rosales A, Pueyrredon EP, Patané AK.
Source
Department of Thoracic Surgery, Instituto Fleming, Buenos Aires, Argentina. mrosenberg@arnet.com.ar
Abstract
Breast cancer frequently metastasizes to the bone. When the sternum is involved, it usually presents as a solitary lesion. In such cases, resection is indicated, including with the intention to cure. This case report describes a technique for a complete exeresis of the sternum, ex vivo repair under hypothermia, and reimplantation. Cryosurgery is a well-known technique to resect bone metastases and was the procedure used in our patient. The follow-up after 2 years shows no evidence of tumor recurrence, with excellent results on aesthetic levels.
Copyright Â© 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PMID: 21256319
J Med Case Reports. 2010 Mar 1;4:75.
Solitary metastatic adenocarcinoma of the sternum treated by total sternectomy and chest wall reconstruction using a Gore-Tex patch and myocutaneous flap: a case report.
Daliakopoulos SI, Klimatsidas MN, Korfer R.
Source
Herz-und Diabeteszentrum Nordrhein Westfalen, Georgstrasse 11, Bad Oeynhausen, Universitätsklinikum der Ruhr-Universität Bochum, Germany. sdaliakopoulos@hotmail.de.
Abstract
ABSTRACT:
INTRODUCTION:
The consequences of bone metastasis are often devastating. Although the exact incidence of bone metastasis is unknown, it is estimated that 350,000 people die of bone metastasis annually in the United States. The incidence of local recurrences after mastectomy and breast-conserving therapy varies between 5% and 40% depending on the risk factors and primary therapy utilized. So far, a standard therapy of local recurrence has not been defined, while indications of resection and reconstruction considerations have been infrequently described. This case report reviews the use of sternectomy for breast cancer recurrence, highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic diseases, and suggests the use of serratus anterior muscle flap as a pedicle graft to cover full-thickness defects of the anterior chest wall.
CASE PRESENTATION:
We report the case of a 70-year-old Caucasian woman who was referred to our hospital for the management of a retrosternal mediastinal mass. She had undergone radical mastectomy in 1999. Computed tomography and magnetic resonance imaging revealed a 74.23 x 37.7 x 133.6-mm mass in the anterior mediastinum adjacent to the main pulmonary artery, the right ventricle and the ascending aorta. We performed total sternectomy at all layers encompassing the skin, the subcutaneous tissues, the right pectoralis major muscle, all the costal cartilages, and the anterior part of the pericardium. The defect was immediately closed using a 0.6 mm Gore-Tex cardiovascular patch combined with a serratus anterior muscle flap. Our patient had remained asymptomatic during her follow-up examination after 18 months.
CONCLUSION:
Chest wall resection has become a critical component of the thoracic surgeon's armamentarium. It may be performed to treat either benign conditions (osteoradionecrosis, osteomyelitis) or malignant diseases. There are, however, very few reports on the results of full-thickness complete chest wall resections for locally recurrent breast cancer with sufficient safety margins, and even fewer reports that describe the operative technique of using the serratus anterior muscle as a pedicled flap.
PMID: 20193081 [PubMed - in process] PMCID: PMC2844379 Free PMC Article

Gan To Kagaku Ryoho. 2009 Dec;36(13):2627-30.
[A case of advanced breast cancer with multiple bone metastases responding to docetaxel and high-dose toremifene as fourth-line chemo-endocrine therapy].
[Article in Japanese]
Minamoto K, Ikeda T.
Source
Dept. of Surgery, Tamano Citizen Hospital.
Abstract
A 55-year old woman, who underwent left mastectomy (Bt+Ax), was revealed to have sternum metastasis by postoperative 99mTc bone scanning(T1bN1M1). She received daily aromatase inhibitor (anastrozole), as a primary systemic endocrine therapy, and biweekly pamidronate for metastatic breast cancer. However, she depended on folk medicine a year later, at which time the primary treatment was discontinued. Another year later, the bone metastases developed with increased serum levels of tumor markers (CEA, CA19-9, and NCC-ST-439). Then, she underwent three different regimens of systemic chemo-endocrine therapy over the following three years, including CAF+MPA as the first-line, paclitaxel (PTX) + anastrozole as the second-line, and S-1+anastrozole as the third-line regimen. She recently completed 10 courses of the fourth-line regimen[tri-weekly docetaxel (DOC) and high-dose toremifene (TOR 120 mg/day)], which reduced levels of 99mTc accumulation in the multiple bone metastases and levels of the serum tumor markers to the normal range. No severe adverse events occurred except peripheral thrombovasculitis (grade 2) in her left anterior arm during the fourth regimen. She recently maintains the current status by taking a regular dose (40 mg/day) of toremifene for 5 months. Combination treatment with DOC and high-dose TOR can be one of the worthwhile regimens as systemic chemo-endocrine therapy for patients with advanced breast cancer who develop bone metastases.
PMID: 20009468
Curr Oncol. 2008 Aug;15(4):193-5.
Sternal resection for recurrent breast cancer: a cautionary tale.
Lee L, Keller A, Clemons M.
Source
Division of Medical Oncology, Princess Margaret Hospital, Toronto, ON.
Abstract
The occurrence of a solitary sternal metastasis from breast cancer is relatively uncommon, and its treatment is controversial. Most case reports on the role of sternal resection in what is termed a "solitary sternal metastasis" tend to present a rather optimistic outcome.Here, we report the case of a premenopausal woman with axillary lymph node-positive, triple-negative breast cancer treated with mastectomy followed by adjuvant chemotherapy and radiation therapy. She developed a radiologically isolated sternal recurrence 3 years later, which was treated with partial sternectomy. The present case report reviews the use of sternectomy for breast cancer recurrence and highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic disease before extensive surgery is undertaken.
PMID: 18769608 [PubMed] PMCID: PMC2528306 Free PMC Article

Anticancer Res. 2007 Nov-Dec;27(6C):4259-62.
Percutaneous combined therapy for painful sternal metastases: a radiofrequency thermal ablation (RFTA) and cementoplasty protocol.
Masala S, Manenti G, Roselli M, Mammucari M, Bartolucci DA, Formica V, Massari F, Simonetti G.
Source
University Hospital, Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Viale Oxford 81, 00133 Rome, Italy. salva.masala@tiscali.it
Abstract
BACKGROUND:
Radiofrequency thermal ablation (RFTA) has recently been introduced for the treatment of painful bone metastases. We report the outcome of one combined protocol session of percutaneous RFTA and cementoplasty on a painful sternal breast cancer metastasis of a 66-year-old patient.
PATIENTS AND METHODS:
A sternal lesion was identified at a repeated CT scan during the oncological follow-up. Due to severe chest pain, the patient was treated percutaneously to obtain pain relief and bone stabilization. Percutaneous RFTA was performed using a 15-gauge needle electrode (MIRAS TX-120) coaxially introduced through a 13-gauge bone biopsy needle. The lesion was heated up to 80 degrees C for 3 minutes. A percutaneous injection of 1 cc polymethylmethacrylate in the central part of the lesion was performed immediately after the RFTA procedure.
RESULTS:
Immediate symptomatic improvement was documented.
CONCLUSION:
Combined percutaneous therapy showed feasibility and effectiveness and can be considered as an alternative for the treatment of painful bone metastases.
PMID: 18214029
Surg Today. 2006;36(3):225-9.
Resection of sternal tumors and reconstruction of the thorax: a review of 15 patients.
Haraguchi S, Hioki M, Hisayoshi T, Yamashita K, Yamashita Y, Kawamura J, Hirata T, Yamagishi S, Koizumi K, Shimizu K.
Source
Department of Surgery, Nippon Medical School Second Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
Abstract
PURPOSE:
We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh.
METHODS:
Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two.
RESULTS:
All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months.
CONCLUSIONS:
Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.

the following is an old_pre her2 measurement being routine_ article:
Ann Oncol. 2003 Aug;14(8):1234-40.
Comparison between solitary and multiple skeletal metastatic lesions of breast cancer patients.
Koizumi M, Yoshimoto M, Kasumi F, Ogata E.
Source
Department of Nuclear Medicine, Cancer Institute Hospital, Tokyo, Japan. mitsuru@jfcr.or.jp
Abstract
BACKGROUND:
Breast cancer has been the subject of many recent studies because it is a significant cause of death in women. This study was performed to clarify whether solitary skeletal metastasis has clinical significance compared with multiple skeletal metastasis.
PATIENTS AND METHODS:
Seven hundred and three patients who developed metastatic bone lesions up to September 2002 after beginning treatment for breast cancer from 1988 to 1998 were included. The lesions were classified first as solitary or multiple based on bone scan results and then according to anatomical distribution. Next, solitary-to-multiple conversion was investigated in patients with solitary skeletal metastasis. Then factors related to solitary or multiple skeletal metastasis were analyzed. The prognosis of skeletal metastasis was compared between patients with solitary or multiple metastatic bone lesions. A Cox proportional hazards model was used to test whether solitary skeletal metastasis compared with multiple skeletal metastasis was an independent factor of survival.
RESULTS:
Two hundred and eighty-nine patients (41%) had solitary skeletal metastasis and 414 patients (59%) showed multiple skeletal metastasis. The sternum was a frequent site for solitary skeletal metastasis (98 of 289, 34%), while other skeletal sites were more frequent in patients with multiple metastatic bone lesions (P <0.001). Solitary sternal metastatic lesions remained solitary longer than solitary metastatic bone lesions to places other than the sternum (P <0.001), but did not lengthen patient survival times (P = 0.871). The factors related to solitary skeletal metastasis are TNM stage (tumor-node-metastasis) and histology. The patients with earlier stage and favorable histology tend to have solitary skeletal metastasis. The patients with solitary skeletal metastasis lived longer than those with multiple metastatic bone lesions (P <0.001). Multivariate analysis revealed that a solitary metastatic bone lesion (P = 0.002) is an independent favorable prognostic factor in patients with skeletal metastasis.
CONCLUSIONS:
Solitary skeletal metastasis has a different anatomical distribution and is an independent prognostic factor in patients with skeletal metastasis.
PMID: 12881385

PMID: 16493530

If you go to the Stanford University Medical center site I seem to remember they have ways to contact them to ask about their cyberknife--ask them about their experience with sternal mets which have previously been irradiated. Other treatment modalities are being developed --I know Dr. Wapnir at Stanford has a clinical trial using radioactive iodine against her2+ brain mets which have the Na-I symporter demonstrated on biopsy but don't know if anyone is doing a similar trial with bone mets. Keep on checking clinical trials, they keep adding more all the time.

But don't panic-- just use the same amount of energy you would spend worrying on getting information that may help you now or in the future ie, build up your armaments!!

Good luck!