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MRM With Axillary Dissection Done. What Is The Cure Rate With Sterotactic Radiotherapy? Will It Spread The Disease?
Question: my wife aged 49 had right mrm with axillary dissection on 22 -12-2009. she had 3x3x2 cm tumor invasive and 12 axillary + nodes and 2 apical nodes. er/pr+ her -ve histology grade 3. On 09-1-2010 her pet/ct showed no residual local disease she osteolytic lesion in l5,4,2 and sternum, having 9.3 suv with corresponding changes in ct and osteolytic changes in c6 d2 d11,12 without any corresponding ct changes . then she had 21/6 cycles of docetaxel+ epirubicin+ cyclophospomide followed by chset and rt supraclvicular irradiation. then her bone scan showed all bone lesions cleared except sclerotic changes in l5,4. she was put on anastrozole +zometa monthly. then on follow upon nov 2010 her ca 15-3 ---14.3 her pet/ct reported siginificant recovery with post treastment changes in lungs ,and increased sclerotic changes in old vertebral lesions suv was 4.6.. zometa then made 3 monthly. later her ca 15-3 on
Feb 2011 was 16.4 on 21-01-2012 her ca 15-3 was 9.3 and her pet/reported persistant vertebral sclerotic lesion of esssentially same size but fdg uptake was changed to 5.9 there was no other lesion reported her lung changes disappeared.. her performance and activities at present are almost normal.At present she has no pain any were..
My worry and query is regarding future management.in the light of encouraging response and cure rate with sterotactic radiotherapy,and cost good centers for it and its usefullness in my wifes case .I am scared that too much waiting can perhaps lead to spread of disease .Or shall i wait and observe...
Please be helpful and guide me
Feb 2011 was 16.4 on 21-01-2012 her ca 15-3 was 9.3 and her pet/reported persistant vertebral sclerotic lesion of esssentially same size but fdg uptake was changed to 5.9 there was no other lesion reported her lung changes disappeared.. her performance and activities at present are almost normal.At present she has no pain any were..
My worry and query is regarding future management.in the light of encouraging response and cure rate with sterotactic radiotherapy,and cost good centers for it and its usefullness in my wifes case .I am scared that too much waiting can perhaps lead to spread of disease .Or shall i wait and observe...
Please be helpful and guide me
Dear XXXXXX,
Thanks for writing in.
I am afraid that your wife had metastatic disease to start with and it is not possible on today's date to cure it. The only good thing is that she had the spread limited to bones only and had a good response to therapy. Currently she is mainlining the response to hormonal therapy.
Some patients with bone-only metastatic disease may have long duration of control (5-10 years). I sincerely wish she falls within this category.
As of now, you need to continue the anastrozole with periodic imaging (PET-CT or bone scans). At this point I don't think there is any need of stereotactic radiotherapy. There is no reason to believe that it will lead to cure. We can reserve it for a later date if she has pain over those sites and there is evidence of disease flare at those sites.
Hope I have answered your query. I will be happy to answer any follow-up queries.
Best Wishes,
Thanks for writing in.
I am afraid that your wife had metastatic disease to start with and it is not possible on today's date to cure it. The only good thing is that she had the spread limited to bones only and had a good response to therapy. Currently she is mainlining the response to hormonal therapy.
Some patients with bone-only metastatic disease may have long duration of control (5-10 years). I sincerely wish she falls within this category.
As of now, you need to continue the anastrozole with periodic imaging (PET-CT or bone scans). At this point I don't think there is any need of stereotactic radiotherapy. There is no reason to believe that it will lead to cure. We can reserve it for a later date if she has pain over those sites and there is evidence of disease flare at those sites.
Hope I have answered your query. I will be happy to answer any follow-up queries.
Best Wishes,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Your observation that disease flare scares me , hence thinking of sterotactic local treatment so visceral spread can be prevented. Also can anastrozole and zometa rectify lesion. This make or break situation has disturbed me a lot Hence requesting you to guide me .I am clinical practationer had my MBBS in 1978..
Thanks
Thanks
Stereotactic radiation cannot prevent spread of disease to viscera later, it is only for local control.
Anastrozole and zometa can definitely control the disease for certain period of time, which varies from patient to patient. But as I said, cure is not a realistic goal of therapy.
Anastrozole and zometa can definitely control the disease for certain period of time, which varies from patient to patient. But as I said, cure is not a realistic goal of therapy.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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