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breast cancer and lymph nodes
FGJ
Posted: Friday, March 27, 2009 4:53 PM
Joined: 3/27/2009
Posts: 1


Dear Doctor:

I was diagnosed with HER2+ breast cancer in my right breast in October 2008.  I had a breast biopsy  and a lymph node biopsy (which was negative) and 5 days later I had a PET/CT Scan.  My tumor measured 2.7 cm and 4 lymph nodes showed positive for FDG. They were near my collar bone.  I started neoadjuvant chemotherapy and had a second PET/CT scan done in January 2009.  This time the tumor was not visible and only 2 lymph nodes showed  a minimal uptake of FDG.  March 10th I underwent a sentinel nodes biopsy and had 3 other lymph nodes removed.  All four were negative and not near my collarbone.  I also had a simple skin sparing mastectomy and immediate reconstruction using an LD flap and a small saline implant (delayed reconstruction was not a decision I could live with).  My pathology report showed a complete pathological response to the chemo; no remaining tumor and no cancer cells in the tissue.  My medical oncologist and my plastic surgeon feel the first PET/CT scan was skewed  because it was done too soon after my biopsy and they feel the lymph nodes were never cancerous.  They do not believe I need or would benefit from radiation.  I met with a radiation oncologist today who told me I have a 33% chance of reoccurence without radiation to my chest wall and my lymph nodes.  Is this correct?  If I do need radiation can I have it with the cyber knife and only target those nodes that might have been positive and can it target my chest wall with minimum damage to my reconstructed breast? Any information you can give me will be greatly appreciated.

Thanks,

FGJ


Dear Doctor:

I was diagnosed with HER2 positive breast cancer in October 2008 and underwent 4 months of neoadjuvant chemotherapy, a sentinel node biopsy, a skin sparing mastectomy and immediate reconstruction using an LD flap and a small saline implant.  My pathology report came back clean; no remaining tumor and no cancer cells found anywhere.  My sentinel node was negative and 3 other nodes were also negative.  My original PET/CT scan was done 5 days aft

radsrus
Posted: Friday, March 27, 2009 5:01 PM
Joined: 10/10/2008
Posts: 4435


CK is not an option. It is difficult to say whether those nodes were originally involved. If you receive radiation there is a chance you will end up losing the implant some time in the future, and would then require a reconstruction with some sort of a flap or graft. On the other hand, if the lymph nodes were involved, the radiation oncologist is correct. In fact, there is a survival advantage for women receiving post-mastectomy radiation with any positive nodes in some studies, although the data is more questionable for 1-3 positive nodes. If it were me, I would get radiation, but I think you could make a different choice if it makes you more comfortable. In short, if you get radiation you may have a better survival chance but higher chance of losing the implant. If you don't get radiation, the opposite is true.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


elle
Posted: Sunday, September 06, 2009 5:28 PM
Joined: 9/6/2009
Posts: 10


As surgery is not an option I am being considered for cyber-knife. I have secondary breast cancer in two areas by my heart, one attached to the pulmonary artery and the other slighty higher. My left vocal cord is paralysed and I have a shortness of breath due to the growth pressing on the nerve of the left vocal cord and the wind-pipe. I have had 9 months of chemo, 6 months of avastin with taxol, followed with 3 months of caelyx, but the growths still remain. I have been told that fidicules have to be inserted arround the tumor, either through the chest wall or by going down the gullet. I am nervous of the procedure, but how successful can this treatment be?


radsrus
Posted: Monday, September 07, 2009 9:09 AM
Joined: 10/10/2008
Posts: 4435


For any type of tumor in any location there is a 70-90% chance of control. THe size of the tumor probably does make some difference in the control rates, and location is important in determining the risks.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


elle
Posted: Wednesday, September 09, 2009 5:18 AM
Joined: 9/6/2009
Posts: 10


There are two tumors back to back in the same area, however both are small in the region of 3cm approx. A cardiac specialist is going to place the marker into the tumor by going down the gullet as it is too risky through the chest.
They are hoping to obliterate the tumors. I have been told by my breast surgeon that this is not a cure, but my oncologist says I could be cancer free.
Would it be an advantage to take a biopsy if this is possible and will the paralysis of my left vocal cord ever right itself once the tumor is gone or has the nerve been damaged?
Thank you.
Elle

radsrus
Posted: Wednesday, September 09, 2009 12:48 PM
Joined: 10/10/2008
Posts: 4435


The vocal cord will probably not come back, but an ENT surgeon can place a strut in it under local anesthesia and greatly improve the voice quality. Cancer free means we can't find any cancer. Cured means we never again find it. Both of your doctors may be right. I doubt a biopsy would help much.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


elle
Posted: Sunday, September 20, 2009 5:22 AM
Joined: 9/6/2009
Posts: 10


 

Dear Doctor,

Thank you for your reply.

I am having the marker placed tomorrow as an endoscopic procedure. I have discussed with the ENT specialist about having a biopsy and this is my decision. My breast surgeon thinks if the biopsy causes a bleed it may halt the treatment and  may not make a difference to future treatment anyway, but the cancer hospital. say breast tissue can change from being HER2 negative, as in my case, to HER2 positive and then I could be given Herceptin.and not have cyber-knife.They would control through medication. For me it would confirm 100%  that it was breast cancer as a biopsy in this area has never been taken, although the PET indicates desease and I have a paralysed vocal cord. Both nodules are less than 1cm at this time and not 3cm as originally stated.Are you still of the opinion a biopsy would not be of benefit and do you think cyber-knife is the way forward for me?

With thanks,

Elle


radsrus
Posted: Sunday, September 20, 2009 6:21 AM
Joined: 10/10/2008
Posts: 4435


I think the biopsy decision is up to you and your doctors. I would bet it is breast cancer, but proving that is not a bad idea. I would still vote for CK if it can be done, regardless of HER-2 status. More reliable.

 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


elle
Posted: Sunday, September 20, 2009 6:25 AM
Joined: 9/6/2009
Posts: 10


Thank you for your help and advice.

Elle


elle
Posted: Wednesday, September 30, 2009 2:24 PM
Joined: 9/6/2009
Posts: 10


I am just about to undergo cyberknife treatment for secondary breast cancer.The procedure could not go ahead as planned as the 'marker' was a fractionally  large for the endoscopic equipment and one had to be made to size. There are two cancerous lymph nodes about 1cm in the pulmonary window by my heart and pressing on the windpipe. Due to the position surgery is not an option. My left vocal cord has become paralysed as the cancer has damaged nerves in my chest. I am very anxious as a gold 'marker' will be placed into the tumor via the oesophagus and a biopsy taken. The marker stays there for life and this is used for the focused radiotherapy. Am I right to be concerned about the procedure and could it actually rid me of this cancer? What are the risks of side effects and further mets compared with chemo?
With thanks.

radsrus
Posted: Wednesday, September 30, 2009 2:52 PM
Joined: 10/10/2008
Posts: 4435


It could rid you of the cancer you now have. It remains to be seen whether anything else will come up. Because we have only recently become able to control metastases such as this with any reliability, the whole field of oligometastatic (few metastases) disease is poorly defined


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Dr. J
Posted: Wednesday, September 30, 2009 3:19 PM
Joined: 10/11/2008
Posts: 1070


I would not worry much about the gold seed fiducial marker.  It is inert and causes no symptoms or problems.  The placement itself and the biopsy procedure entail some small degree of risk, no different from a standard biopsy procedure.

 

Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

 

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717


elle
Posted: Thursday, October 01, 2009 10:43 AM
Joined: 9/6/2009
Posts: 10


A leading cancer hospital advise me not to have ck as it is not proven to control small nodule breast cancer in the para-tracheal area.The fdg uptakes suvmax 7.4, previously 8.7 and a new growth suvmax 7.2. The first has reduced in uptake since taking aromasin, but the second is a new finding and has caused paralysis to the vocal cord. The size ot both is about 1 cm.

My oncologist sent me to a cyberknife centre as he feels this could get rid of the cancer, but I've had so many burning skin reactions to previous radiotherapy and chemo, where I've ended up in hospital. Nine months of chemo did not get rid of the growths in my chest.

I'm not sure which way to go with two conflicting opinions.


radsrus
Posted: Thursday, October 01, 2009 10:52 AM
Joined: 10/10/2008
Posts: 4435


It is highly likely that suitably aggressive treatment with the CK would eliminate that tumor nodule. It might no affect survival because of other disease developing.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


elle
Posted: Thursday, October 01, 2009 5:29 PM
Joined: 9/6/2009
Posts: 10


These cancers appear to be slow growing and have been there for about 6 years being controlled by chemo over this time, usually responding to treatment. However this time one node remained and another returned after chemo.Would CK give me a better chance of survival if the cancer is slow growing or could CK increase the risk of  the cancer retuning?

With thanks


elle
Posted: Thursday, October 01, 2009 6:21 PM
Joined: 9/6/2009
Posts: 10


Is it usual for the disease to progress or could I be cancer free for years if CK works? In short could CK give me a better chance of survival?
radsrus
Posted: Friday, October 02, 2009 12:35 AM
Joined: 10/10/2008
Posts: 4435


Possibly. Conventional wisdom says that you don't cure people with metastatic disease, but we are re-defining a new concept of oligometastatic disease. All I know for sure is that controlling those two tumors will not be likely to shorten your survival, and is worth the effort. We use a "whack a mole" strategy - when something pops up, we whack it, and continue to do so as long as it makes sense.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


elle
Posted: Saturday, October 17, 2009 4:49 PM
Joined: 9/6/2009
Posts: 10


Thank you for your support and advice. I had the fiducial placement two weeks ago via the oesophagus and a biopsy taken at this time confirms breast cancer, HER2 negative, oestogen+. I have been coughing continually since the placement.Could this be due to the fiducial or paralysed vocal cord? The CT scan shows the cancer has not increased in size that much, two lymph nodes 1.5cm. The cyberknife begins on Monday for three days and I have been told about possible risks to the oesophagus ie. swelling and a burning sensation with a sore throat and difficulties swallowing. Are these symptoms temporary or could they cause permanent damage?  Previously I had severe burns from general radiotherapy, where my treatment had to be stopped.It is possible they will reduce the dose by 10%. What are the risks of cyberknife to the para-tracheal area?

With thanks,

Elle


Dr. J
Posted: Sunday, October 18, 2009 5:04 AM
Joined: 10/11/2008
Posts: 1070


The fiducial itself should not cause any symptoms although the placement procedure could cause temporary irritation. Usually any symptoms related to the CK treatment would be temporary and last only a few days or weeks but there are long-term risks which should have been discussed with you by your treating radiation oncologist.  You really need to speak to him/her for the particulars of your case and the potential side effects or risks.



 

Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

 

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717


elle
Posted: Wednesday, October 28, 2009 4:38 PM
Joined: 9/6/2009
Posts: 10


Dear Doctor,

I have completed the cyberknife treatment and so far not had any adverse side-effects. The coughing stopped for a few days, but has now returned and my voice is still very weak, probably due to the paralysed vocal cord. I feel very tired and drained of all energy, but I am managing to get out now. I was told that I would not be scanned for a few months. If the treatment has been successful would I feel any different and would I still be coughing? Can the treatment go on working?

Elle

 


radsrus
Posted: Wednesday, October 28, 2009 4:42 PM
Joined: 10/10/2008
Posts: 4435


You might not feel any different. Treatment is still working. You will just have to wait on the scans.


 

Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org

Mail to:
Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave. #101
Oklahoma City, OK 73102

 


Dr. J
Posted: Thursday, October 29, 2009 4:18 AM
Joined: 10/11/2008
Posts: 1070


Fatigue is normal after CK treatment, but usually lasts only a few days or a week or two and then goes away.

 

Jerome J. Spunberg, M.D., FACR, FACRO
CyberKnife Center of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

 

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717


 

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