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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!

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!

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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