Found some medical articles going over radiation post mastectomy

This is a bit too techie, and I probably should not be doing a 'deep-dive' but thats just me I have to dig into stuff to make an informed decision since I am trying to get a feel for the following:

- is it good to get another surgery to remove more lymph nodes ?
- is dose-dense chemo more effective in the long term ?
- pros and cons of radiation after chemo in cases like mine.



I received the following information from a forum that I had posted to regarding getting radiation after mastectomy for those who were node positive ( I had 2 out of 6 lymph nodes removed at the sentinel node biopsy test positive)


A. Here are 3 classic, often cited papers on post mastectomy radiation therapy (PMRT):

1. Overgaard M, Hansen PS, Overgaard J, et al: Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 337: 949-955, 1997[Abstract/Free Full Text]


2. Ragaz J, Jackson SM, Le N, et al: Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med 337: 956-962, 1997[Abstract/Free Full Text]

3. Whelan TJ, Julian J, Wright J, et al: Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18: 1220-1229, 2000[Abstract/Free Full Text]

B. Here is an excellent 2005 Review of the Literature on PMRT: REVIEW ARTICLE: The Use of Radiotherapy After Mastectomy: A Review of the Literature Lori J. Pierce http://jco.ascopubs.org/cgi/content/full/23/8/1706


C. Here is the 2001 ASCO (American Society of Clinical Oncology) Position Paper on PMRT with current citations (a very long article to read but recent (2004-07) citations at the end of the paper may act to further reinforce the 2001 written guidelines):

ASCO SPECIAL ARTICLES Postmastectomy Radiotherapy: Clinical Practice Guidelines of the American Society of Clinical Oncology* http://jco.ascopubs.org/cgi/content/full/19/5/1539


PLEASE NOTE: the understanding and consideration of Post Mastectomy Radiation Therapy merits in-depth discussions with your oncologist, surgeon and radiation oncologist(s) as breast cancer biology, risk and prognosis prediction (genes and proteins), and treatment (chemotherapy and hormone therapy) has rapidly evolved over the last decade and continues to do so. Please push yourself to fully understand the risks to radiation as well as the possible benefits. This information is on post mastectomy radiation therapy, and does not apply to lumpectomy surgery where the benefit of radiation to reduce recurrence has clearly been shown, and hence allows lumpectomy and radiation to equal mastectomy in overall survival.

What I personally deducted from this information ( have just browsed through it ) was summarized in this paragraph from one of the articles:

The Panel found that the weight of the evidence from randomized trials was sufficient to recommend the routine use of PMRT for patients with four or more positive axillary lymph nodes. It is much less certain that the benefits of PMRT are sufficient to justify its use in most patients with T1/2 tumors with one to three positive nodes. The available evidence is insufficient to make recommendations for this subgroup. Further randomized trials (such as a recently opened intergroup trial in North America) are justifiable for this subgroup of patients. There are few data from randomized trials for patients with T3 or locally advanced (stage III) operable cancers, but the evidence from retrospective studies is sufficient for the Panel to suggest that PMRT be routinely used for such patients. While the consensus of the Panel was to suggest the use of PMRT for most patients treated with neoadjuvant systemic therapy, the Panel could not find sufficient evidence to determine whether all patients should be irradiated after neoadjuvant systemic therapy.


Maybe thats why the 1st group is trying to figure out my #node involved by going in and removing more nodes... hmm....