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?

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.

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.