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Q. Radiation therapy was suggested after total axial node dissection. Kindly give a second opinion.

Answered by
Dr. Pratik Patil
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 04, 2021

Hi doctor,

Can you please give me a second opinion on breast cancer treatment?

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Hi,

Welcome to icliniq.com

According to your report (attachment removed to protect patient's identity), post-mastectomy status is as follows:

  • She is a 36-year-old female with two tumors in the resected breast in 11 o' clock and 1 o' clock position, which are more than 1.5 cm in size and also has the same side axillary lymph node of 19 mm with Ene+ (extranodal extension), ER/PR (estrogen receptor/progesterone receptor) ++, HER2 (human epidermal growth factor receptor) -- status and luminal A type cancer.
  • Prosigna test recurrance score is 6%.
  • Node-negative cancers are classified as low (0 to 40), intermediate (41 to 60), or high (61 to 100) risk, and node-positive cancers are classified as low (0 to 40) or high (41 to 100) risk.
  • She falls into the node-positive group; therefore, a risk of 6% mentioned in your report is considered low.

I would suggest the following treatment plan:

  1. Endocrine therapy alone for five years with tablet Tamoxifen + Leuprolide acetate.
  2. We can spare chemotherapy.

Hi doctor,

Thank you for the response.

We consulted with the local doctors and they are advising to take radiation therapy. Kindly tell me if it is required as the patient has already done total axillary node dissection. Can you tell me why doctors are still suggesting radiation and also if we can take high-dose Vitamin C in IV during the course of radiation therapy?

#

Hello,

Welcome back to icliniq.com

As we are skipping chemotherapy and also because it is a multicentric tumor (two tumors are resected at 1 o' and 11 o' clock position), radiation therapy is required.

We have two options: either go for chemotherapy and avoid radiation or go for radiation therapy along with endocrine therapy.

I would suggest you to go for the second option because it is easier and better. And also as far as you are concerned, the prosigna test suggests no many benefits for chemotherapy.

Thank you.


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