Expert: Claes-Gustaf Nordquist, M.D. - 6/9/2008

Question
QUESTION: I had a mastectomy and removal of lymph nodes, December 2007, diagnosed with triple negative ductal invasive breast carcinoma, Grade 3, no nodal involvement and no distant metastases.  Received 6 cycles at 3 weekly intervals of cyclophosphamide and taxotere. I discovered a lump along the scar, 2 weeks after the 6th cycle.  It may have been there longer, but I had not examined the area. Biopsy showed a local recurrence of the cancer. Am now waiting for PET scan to see if it has spread. Oncologist says if it has not, my surgeon will remove the lump and I will receive radiation to the area.  If it has spread he is proposing giving me Gemzar and  Carboplatin at three weekly intervals at, one drug at day 1 and the 2nd at day 8. He suspects it  may have spread to my left lung as ct scan showed a nodule 4mm and I had a wheeze, in the area on examination, also slight cough.  What is your opinion on the proposed plan of action? Thanks, Norah

ANSWER: At this point in time I have no objection to the suggested plan. The only thing I'm somewhat critical of is the fact that you were not given radiation therapy after surgery in the usual way. We will see what your situation is when all the results are in. Please do keep me posted!


---------- FOLLOW-UP ----------

QUESTION: I was due to have 6 weeks of radiotherapy, when I completed the chemotherapy, (30 sessions.) Do you mean that I should have had radiotherapy, before chemotherapy, after surgery, or should I have had radiotherapy at the same time as chemotherapy? Thanks, Norah

Answer
Ok, so it WAS planned. You just had not mentioned it in that context. I would probably have planned any radiation before chemo. But there are no firm rules on that point. It depends on the condition of the patient too. To do it at the same time may be pushing it too far.