Expert: Claes-Gustaf Nordquist, M.D. - 12/14/2010

Question
Hello, Dr. Nordquist,
I am 52 y.o. diagnosed in 2007 with Her-2nu+, estrogen + stage 2 CA in right breast with one lymph node out of 3 tested +.  Had mastectomy on right, chemo, 1 year of Herceptin in 2008, had recurrence in right axillary node and a possible node showing uptake of 6 in hilar region, used xeloda with complete response both areas. Currently,  had another PET CT showing an area where past small possible node and another possible node uptake of almost 6 on PET CT.  Oncologist recommending xeloda and changing herceptin to tykerb.  Says no Radiologist will "get excited" about using radiation on these tiny possible node involvment areas in my chest but will refer for consult if I insist... says metastatic and not curable, so radiation not an option.  I have read and spoken with rep from an oncology group claiming that radiation is an option at their practice.  Now, not sure what to do!  Also, have Rheumatoid Arthritis with many new nodes on joints all over my body.  And thinking possible sarcoidosis according to primary care MD...  RA went away totally while on Xeloda.

Answer
It may be difficult to provide good enough radiation therapy there but it may not be impossible. So if I was in your situation I would let that group take a look at the problem. Even so, I think you will also need chemotherapy along the suggested lines even if irradiation is possible since the risk IS big that this now is a general not curable illness and that would be the only way to keep control of it as much as possible and for as long as possible! Good luck!




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