What dose/fractionation would you use for a patient with unresectable, ER+/PR+/HER2 negative breast cancer who declines chemotherapy and progresses locally after receiving endocrine therapy with abemaciclib?

I think there are a few approaches to this. I would first discuss with my surgeon, what makes the patient unresectable. One consideration if borderline resectable is neoadjuvant RT, I use this study as a guide though sounds like the patient may refuse capecitabine (Woodward et al., PMID 28843370).

If not felt to be a surgical candidate at all, I think there are a few options:

1. Palliative RT- treatment for symptoms only
2. Definitive dose escalation +/- capecitabine- this can be considered but can be associated with significant acute and late toxicity

I typically dose to 50 Gy and boost gross disease to 60-70 Gy based on DVH. If skin involvement, will use bolus but have to watch skin side effects.