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Forum Name: Breast Cancer

Question: time between axillary lymph dissection and chemo


 starting now - Sun Aug 09, 2009 4:07 pm

I had a simple mastectomy less than a week ago. One sentinal node had cancer cells, and my surgeon recommends doing axillary node dissection...probably taking 10-12 more lymph nodes. I am going to want to have chemotherapy in a different state (if needed) and I'm worried about taking too long. How long will I have to heal before being able to jump a plane and is waiting to start chemo until I find an oncologist in the new place dangerous? I'm 62, had a 1.2 cm invasive ductal. It was estrogen/progesesteron receptive and the third marker (can't remember what it was) was negative. The axillary surgery is taking place 2 and 1/2 weeks after the mastectomy and sentinal biopsy. Am I just worrying too much?
 Dr. Tamer Fouad - Sun Sep 06, 2009 8:45 am

User avatar Hello,

Thanks for your question. Generally speaking, adjuvant chemotherapy is given 1-2 months after surgery. You shouldn't delay adjuvant chemotherapy more than 3 months after the initial surgery, as there is evidence that it loses benefit [1].

You should plan this with your current oncologist, who can help make a referral and an appointment in your new home state.

The other marker you were referring to is HER-2.

Good luck!

REFERENCES:
===========
1. Lohrisch C; Paltiel C; Gelmon K; Speers C; Taylor S; Barnett J; Olivotto IA. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006 Oct 20;24(30):4888-94. Epub 2006 Oct 2.
 starting now - Sun Sep 06, 2009 9:41 am

Is there a danger starting too soon? It's only been 2 weeks and they want to start next week.

Thanks for answering my question.
 Dr. Tamer Fouad - Sun Sep 06, 2009 6:05 pm

User avatar Hello,
Actually this has also been studied. A study conducted at the Royal Marsden Hospital examined the disease-free survival (DFS) and overall survival (OS) of the 368 patients starting chemotherapy within 21 days of surgery (group A) who were compared with 793 patients commencing chemotherapy >or= 21 days after surgery (group B). There was no difference in any of the outcome parameters (OS, DFS) between both groups.[1]

So while delaying chemotherapy beyond 12 weeks is bad for you, as mentioned above, receiving it earlier than 3 weeks after surgery is no different than receiving it later than 3 weeks (but within 12weeks).

It really depends on the treatment plan that will be individualized by coordination between your surgeon and your medical oncologist.

Good luck with your chemotherapy!

REFERENCES:
===========
1. Shannon C; Ashley S; Smith IE. Does timing of adjuvant chemotherapy for early breast cancer influence survival? J Clin Oncol 2003 Oct 15;21(20):3792-7.

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