Hello,
I was diagnosed with stage 1, ER+, HER2+ Grade 3 tumour. After chemo and mastectomy, lymph nodes negative, and only grade 2 spots of cancerous cells in surrounding pre-cancerous micro-calcifications remained (so chemo pretty effective). Awaiting to hear if they are HER2+ plus and I require further chemo or stick with Herceptin injections.
I am currently based and receiving my treatment in France. At my appointment last week with surgeon to get post op results, my surgeon seemed to have changed her mind on if i required radiotherapy or not. At last appointment in December she said I would have radiotherapy (because I had a grade 3 tumour larger than 2cm and I was young - I am 41). Now, she thinks I don’t need it. In France you require two criteria to have radiotherapy after mastectomy. I have one criteria (original tumour was grade 3, larger than 2cm) but another criteria is patient is under 40. As I am just over 40, I feel that this decision is a little arbitrary. I consulted the NICE guidelines and lit review and I think in the UK radiotherapy should be considered (although not necessarily given) in my situation. There was no mention of patient age.
Are you please able to provide any further guidance? I have a follow up appointment with my Oncologist this Friday. My case is being discussed with the multi-disciplinary team before then. I would like further info so I can have a good discussion with my Oncologist and figure out whether I should be arguing for radiotherapy? I am of course concerned about a recurrence in the chest wall. The surgeon said there was some tissue between the tumour and the chest wall but it was not far.
Grateful for any insights and experiences about U-turns on decisions around radiotherapy (is it sometimes also a resource issue?).
Many thanks, Laura
Hi Laura
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Hi laura_sm
Thanks for posting.
Treatments and healthcare services vary so much in different countries, which makes it difficult for us to answer queries on treatment decisions made outside of the UK.
You can read about radiotherapy and when this may be given here in the UK in our information. As you say the criteria for giving radiotherapy following mastectomy here in the UK doesn’t include age. However, patients with a close or positive margin near to the skin or chest wall after mastectomy are often treated with radiotherapy. You can read more about margins in our booklet Understanding your pathology report on page 15.
Guidance on the use of treatments for breast cancer here in the UK, such as radiotherapy, are evidence based rather than made on resource availability.
Having your case discussed at the MDT will mean that all the members of your treatment team will contribute to the recommendation you’re given. Your oncologist will be able to explain the reasoning behind their decision. However, if you still have concerns, you may find it helpful to request a second opinion to get another oncologists view on your diagnosis or treatment.
Kind regards
Catherine
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