Is there a rationale for treating medically inoperable stage I-III breast cancer patients with RT alone?

Topics: Breast Cancer • Radiation Oncology • Medical Oncology

My understanding is that if someone isn’t medically operable, the default is to offer systemic therapy palliatively because breast cancer is thought of as a surgical disease (even though RT can be safely delivered to curative doses because there aren’t adjacent critical structures).

Is there any data (or anecdotal experience) to support treating these patients with radiation alone?

Answer from: Radiation Oncologist at Academic Institution

We treated stage III patients with "radical radiotherapy" with or without chemotherapy when I was a resident in the early 1980s, since they were considered SURGICALLY inoperable then. However, very high doses were needed (75-80 Gy to the primary using external beam followed by interstitial implants)...

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Radiation Oncologist at West Virginia University
I treated only one patient in the mid-90s with def...

Answer from: Radiation Oncologist at Academic Institution

There are two situations I consider RT (without surgery) in these situations: Palliation - if the mass begins to grow and involves skin or deep chest wall, we can offer palliative dose RT. Borderline operable cases - in these scenarios, we often start with systemic therapy. If still borderline, ...

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Radiation Oncologist at University of Texas Health Science Center San Antonio MD Anderson Mays Cancer Center
Agree, I treat "definitively" in the setting of bo...

Answer from: Radiation Oncologist at Community Practice

For inoperable patients or those who refuse surgery, there are multiple case series that report reasonable results with radiotherapy +/- systemic therapy without surgery. Meaningful definitive local control can be achieved. Higher doses are better, but not always feasible for large tumor volumes. An...

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Radiation Oncologist at Beth Israel Deaconess Medical Center
Lots of good discussions! However, as some have po...

Radiation Oncologist at CoxHealth Cancer Center
If one forces the surgeons and anesthesiologists o...

Answer from: Radiation Oncologist at Community Practice

There is a cohort of patients, medically inoperable due to multiple comorbidities and hence not systemic therapy candidates too, we have been offering SBRT with good outcomes, off trial. There is an in-house trial too at Sunnybrook, breast SBRT trial (dose escalation/toxicity endpoints) from which ...

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Radiation Oncologist at Wellspan Sechler Family Cancer Center
What dose and fractionation? What is the target?

Radiation Oncologist at Kingston Health Sciences Centre
CTV high (ITV + 0-5mm) - (35-40/5) CTV low (ITV +...

Radiation Oncologist at CommonSpirit
At least for small breast lesions, there are few p...

Radiation Oncologist at Ashland Radiation Oncology, Inc.
I just saw a 440 lbs patient cT1cN1M0, ER/PR+ Her2...

Radiation Oncologist at Upstate Medical University
Is the Sunnybrook regimen every day or every other...

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