Surgery after 4 Chemos?

[yanyan]

Hi,everyone. I am new to the group. I was dx in Jan 2011 with positive nodes. ER/PR -, Her2 +. My oncologist started me on chemo on Feb 22 ( neo adjuvant ). I have finished 4 cycles of Taxotere/Carboplatin with weekly herceptin. My onco said ususally they do surgery after 2 or 3 chemos but since we were waiting for my BRCA gene test result, it kinda of got delayed till after the 4th chemo. He said i can do surgery now and finish up the rest 2 chemos or i can wait till the end of chemo. I am very confused as he said it does not matter whichever way. I have decided to go with a bilateral mastectomy with immediate reconstruction- Latissimus flap with implants. My concern is: Since i will be off chemo 4 weeks prior and maybe 4 weeks after, i am scared cancer will grow? If my wound does not heal, it will be delayed even more; on the other hand, i am comfortable with the remaining 2 chemos killing residue cells that were not taken out by surgery but since i have already had 4, i think those 4 chemos should have done much of the job already; Also since i will have reconstruction at the time of mastetomy, if i do it now, it will give me plenty of time to get fully expanded prior to radiation. I am confused. Sometimes i wish our doctors can just tell us yes or no. Thanks !!

[Jackie07]

Hi Yanyan,

If you look at the treatment history of many of the 'newly diagnosed' members, you will find quite a few of them have had neoadjuvent chemotherapy. And the chemo combination and schedule seem to be changing every couple of months.

I remember seeing members having 4 AC + surgery + 6 TCH + H,
You did not mention the size of your original tumor. But if the doctor thinks TC/weekly H has been effective shrinking the tumor, it could be the reason why he's comfortable for you to have the surgery in either schedule.

We have quite a few members who have had immediate reconstruction after surgery. Type in 'reconstruction' in the Search box and see if you can get some good information in those threads.

Meanwhile, perhaps more members will chime in and share their view on this dilemma.

[trasia]

hi yanyan,
I also would like to ask for the size of your tumour and what stage your cancer is..

read this too..
http://www2.cochrane.org/reviews/en/ab005002.html

Preoperative chemotherapy for women with operable breast cancer

Chemotherapy for patients with early stage breast cancer has been shown to improve survival. Traditionally, this therapy is given once the patient has undergone surgery. Since the early 1980's, interest has risen in administrating chemotherapy before surgery (known as preoperative or neoadjuvant chemotherapy) based on good results achieved in patients with locally advanced disease (cancer which is larger than 5cm and/or has spread to surrounding tissue or lymph nodes, or both). The rationale for preoperative chemotherapy is that an early introduction of systemic treatment (treatment that affects the whole body) will result in a decrease in the size of the tumour, hence making it possible to do more breast-conserving surgery. For this review, we investigated the effect of the difference in timing of chemotherapy treatment for patients with early stage or operable disease.
This review identified 14 randomised controlled trials involving 5,500 women addressing this question. The analyses revealed no difference in overall survival and disease-free survival for women who received either preoperative or postoperative chemotherapy. Preoperative treatment makes more breast-conserving surgery possible because of shrinkage of the tumour before surgical intervention (relative risk, 0.82; 95% confidence interval, 0.76 to 0.89). However, this also results in a increase of loco-regional recurrence (recurrence in the same area) rate (hazard ratio, 1.12; 95% confidence interval, 0.92 to 1.37). Preoperative chemotherapy provides the possibility of monitoring tumour response and making appropriate regimen changes once the tumour appears to be resistant to the primary therapy. Adverse effects, which were reported in only half of the studies, were fewer in women receiving preoperative chemotherapy. Although, postoperative complications, nausea and vomiting, and alopecia were equally distributed, events of cardiotoxicity were less likely (relative risk, 0.74; 95% confidence interval, 0.53 to 1.04) in women receiving preoperative chemotherapy. Also, serious infection (analysed in 2799 women) was less likely to occur in women receiving preoperative chemotherapy (relative risk, 0.69; 95% confidence interval, 0.56 to 0.84).