How would you manage an elderly female patient with a remote history of synchronous bilateral invasive ductal carcinoma with a new triple-negative recurrence in the left breast and axilla with extension to the contralateral breast?
The patient had been treated with conventional fractionation to bilateral breasts in the past as treatment for her synchronous IDC.
She is currently intolerant of multi-agent chemo and is not a surgical candidate.
Would you consider "definitive" re-irradiation, and if so, what dose and fractionation?
For additional reading, see JCO OGR 11/2021 by @Dr. First Last and @Dr. First Last reviewing landscape of adjuvant treatment after lumpectomy for DCIS, and companion study with longterm outcomes from RTOG 9804 (@Dr. First Last et al).
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on
Unfortunately, if no good systemic options are left including pembro/parp inhibitor then the outcome is most likely palliative. Will try a hypofractionation schedule for palliative/preoperative dose of RT.
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Mednet MemberInvited Expert
Radiation Oncology · Allegheny Health Network, Pittsburgh
Answered on
In these cases, I often hypofractionate and consider hyperthermia. I use 32-40 Gy/8-10 fractions twice weekly with hyperthermia. We have seen good palliative local control in such cases.
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