Radiation Therapy After Chemotherapy for Triple-Negative Breast Cancer

In cases of breast cancer where chemotherapy is administered first followed by a lumpectomy, radiation therapy is typically recommended afterward. This approach is often referred to as neoadjuvant chemotherapy, which aims to shrink the tumor before surgical intervention. After the lumpectomy, radiation therapy is usually prescribed to eliminate any remaining cancer cells in the breast tissue and reduce the risk of recurrence. The specific

Hello, my family member has been diagnosed with triple-negative breast cancer, measuring over 4 cm in the left breast.
They underwent neoadjuvant chemotherapy (8 cycles), and by the 6th cycle, the ultrasound could no longer detect the tumor.
They completed all 8 cycles of chemotherapy, followed by a local excision surgery.
A week later, the pathology report indicated that "the cancer cells are dead." Three sentinel lymph nodes were removed, and none showed signs of infection.

On the same day we received the pathology report, we had our first appointment with a radiation oncologist.
Since my family member had surgery on the left breast, the doctor recommended "self-funded respiratory control" and hypofractionated radiation therapy.
A total of 16 sessions were planned.

I have a few questions:
1.
Will the radiation therapy only target the left breast? Is it the entire left breast or just the area where the tumor was located?
2.
Will the lymph nodes be included in the radiation treatment?
3.
I heard from someone that there was a patient (Patient A) with an identical case who underwent 3 sessions of radiation.
During her second appointment, the radiation oncologist asked if she wanted to increase the sessions to 20 (initially, it was stated that only 16 sessions were needed) because the doctor mentioned treating the original bleeding site, but cancer cells were not clearly visible anymore.
Is it possible for the number of radiation sessions to increase during the treatment process? Given that my family member had chemotherapy followed by surgery with no cancer cells detected, is radiation therapy more challenging to administer? Thank you.

Miss Zhu, 50~59 year old female. Ask Date: 2022/04/14

Dr. Chen Sirong reply Oncology

Ms.
Zhu / 52 years old / Female
1.
Does the family member only need radiation therapy for the left breast? Is it the entire left breast or just the area where the tumor was previously located?
A: The radiation field for the breast includes the area below the collarbone, above the lowest rib, to the left side of the sternum, and half the thickness of the left side of the body.
By general standards, it is the entire left chest.
2.
Will the lymph nodes be irradiated?
A: You did not provide whether the attending physician before chemotherapy believed there were issues with the lymph nodes.
The principle is based on the diagnosis before chemotherapy, not on the absence of issues with the lymph nodes after chemotherapy.
3.
A family member heard from someone else about a case of Patient A with exactly the same situation, who underwent radiation three times.
During the second follow-up, the radiation oncologist asked Patient A if she wanted to increase the sessions to 20 (the first visit indicated only 16 sessions were needed) because the doctor said to irradiate the original bleeding site, but cancer cells were not clearly visible anymore, and they were unsure where to target.
Is it possible for the number of sessions to increase during the actual treatment process?
A: The initial plan was for 16 +/- 4 sessions, with the 4 additional sessions focused solely on the original tumor site as determined by the physician from the beginning.
As long as the physician communicates clearly and the family understands, this is reasonable.
4.
If chemotherapy is done first and there are no cancer cells found after surgery, is radiation therapy difficult to administer?
A: The radiation field is based on the diagnosis prior to chemotherapy, not after.
Please interpret the rest on your own.
Wishing your family member a smooth treatment process.
Taoyuan Hospital, Dr.
Chen Si-Rong.
Thank you.

Reply Date: 2022/04/14

More Info

Radiation therapy is a crucial component in the treatment of breast cancer, particularly for patients with triple-negative breast cancer (TNBC). Given your family member's situation, where they have undergone chemotherapy followed by surgery, it is essential to understand the role of radiation therapy in this context.

1. Target Area for Radiation Therapy: In cases of breast cancer, radiation therapy typically targets the entire breast, especially if a lumpectomy (partial mastectomy) was performed. This is to ensure that any residual cancer cells that may not have been detected are eradicated. In your family member's case, since they had a tumor that was previously measurable and then showed no signs of cancer after chemotherapy, the radiation oncologist will likely recommend treating the entire left breast rather than just the area where the tumor was located. This is to minimize the risk of local recurrence.

2. Involvement of Lymph Nodes: The decision to include lymph nodes in the radiation field often depends on the initial staging and treatment history. Since your family member had three sentinel lymph nodes removed and none were found to be cancerous, the radiation oncologist may choose to focus primarily on the breast. However, in some cases, if there is a concern about potential microscopic disease in the lymph nodes, the radiation field may be expanded to include the axillary region (where the lymph nodes are located). This decision is typically made based on the individual’s risk factors and the oncologist's clinical judgment.

3. Adjustments in Radiation Treatment: It is not uncommon for radiation treatment plans to be adjusted based on the patient's response to prior treatments. If the oncologist observes that the cancer has significantly responded to chemotherapy (as indicated by the absence of detectable cancer cells), they may decide to modify the radiation plan. This could involve changing the number of sessions or the specific areas being treated. In your example of the patient who had their treatment adjusted after initial sessions, this reflects a personalized approach to care, where the oncologist is responding to the patient's unique situation.

4. Importance of Follow-Up: After completing radiation therapy, it is crucial for your family member to have regular follow-up appointments with their oncologist. This will help monitor for any signs of recurrence and manage any potential side effects from the treatment. The oncologist may recommend imaging studies or physical examinations at regular intervals to ensure that any changes in health are promptly addressed.

5. Psychological Considerations: It is understandable to feel anxious about the treatment process, especially after a significant health scare. Encourage your family member to communicate openly with their healthcare team about their concerns and to seek support from family, friends, or counseling services if needed. Emotional well-being is an essential part of the recovery process.

In conclusion, radiation therapy is a standard recommendation following chemotherapy and surgery for triple-negative breast cancer, particularly when there is a history of a sizable tumor. The treatment plan will be tailored to your family member's specific circumstances, including the extent of the disease and response to prior therapies. It is essential to maintain open communication with the healthcare team to ensure that all concerns are addressed and that the treatment plan is optimized for the best possible outcome.

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