Objective: Women with locally advanced breast cancer (LABC) or inoperable local recurrence often suffer from a significantly reduced quality of life (QOL) due to local tumor-associated pain, bleeding, exulceration, or malodorous discharge. We aimed to further investigate the benefit of radiotherapy (RT) for symptom relief while weighing the side-effects. Materials and methods: Patients who received symptom-oriented RT for palliative therapy of their LABC or local recurrence in the Department of Radiation Oncology at Heidelberg University Hospital between 2012 and 2021 were recorded. Clinical, pathological, and therapeutic data were collected and the oncological and symptomatic responses as well as therapy-associated toxicities were analyzed. Results: We retrospectively identified 26 consecutive women who received palliative RT with a median total dose of 39 Gy or single dose of 3 Gy in 13 fractions due to (impending) exulceration, pain, local hemorrhage, and/or vascular or plexus compression. With a median follow-up of 6.5 months after initiation of RT, overall survival at 6 and 12 months was 60.0% and 31.7%, and local control was 75.0% and 47.6%, respectively. Radiation had to be discontinued in 4 patients due to oncological clinical deterioration or death. When completed as initially planned, symptom improvement was achieved in 95% and WHO level reduction of analgesics in 28.6% of patients. In 36% (16%) of patients, local RT had already been indicated >3 months (>6 months) before the actual start of RT, but was delayed or not initiated among others in favor of drug alternatives or systemic therapies. RT-associated toxicities included only low-grade side-effects (CTCAE I°-II°) with predominantly skin erythema and fatigue even in the context of re-RT. Conclusion: Palliative RT in symptomatic LABC or locoregional recurrence is an effective treatment option for controlling local symptoms with only mild toxicity. It may thus improve QOL and should be considered early in palliative patient care management.

https://doi.org/10.1177/15330338231164537

Palliative Radiotherapy for Symptomatic Locally Advanced Breast Cancer

https://doi.org/10.1016/j.adro.2023.101229

Breast-Directed Quad Shot Radiation Therapy for Effective Breast Symptoms Palliation Without Interrupting or Delaying Systemic Cancer Therapy Schedule in Patients With Neglected Breast Cancer

Kilovoltage (kV) radiotherapy, also called superficial radiotherapy (SXT) or orthovoltage radiotherapy (DXT), is a well-known and effective treatment option for non-melanoma skin cancer and some benign skin and musculoskeletal conditions. Given its surface dose delivery, its use in radiation oncology beyond superficial skin cancers is generally limited, but it has also been shown to be extremely useful for specific palliative applications. Here, we describe the characteristics of kilovoltage radiotherapy and report on six cases of locally advanced and/or metastatic breast cancer in which kilovoltage radiotherapy was used as the primary modality or as supportive treatment to linac-based radiotherapy to gain local tumor control and improve the patient’s quality of life.

/pdf/kilovoltage-radiotherapy-as-a-supportive-treatment-in-1cw5dri9.pdf

Kilovoltage radiotherapy as a supportive treatment in locally advanced or metastatic breast cancer – a series of six case reports

Abstract Purpose: We investigated the symptoms and prognoses of patients with fungating breast cancer in the palliative care unit setting. Methods: This study was a sub-group analysis of a multicentre, prospective, observational study. Patients admitted to 23 palliative care units in Japan between January and December 2017 were enrolled. Data of patients with breast cancer were extracted. Wecompared demographic characteristics, symptoms, and prognoses by breast cancer skin lesion status. The primary outcome was overall survival. Secondary outcomes included Palliative Prognostic Index (PPI) score, details about skin lesions, and symptom burden. Results: Of 1,896 patients, 131 (6.9%) had breast cancer. In this cohort, 44 (33.6%) patients had skin lesions. Most skin lesions (88%) were on the backand chest. Some skin lesions were associated with skin redness, erosion, necrosis, or fistula. Symptoms included bleeding, exudate, odour, and pain. Twenty-eight patients (63.6%) needed dressing changes and 14 (31.8%) patients experienced bleeding. None died due to bleeding. In the skin lesion group, 32 (72.8%) patients had used opioids equivalent to 38 mg of oral morphine daily, compared to 25 mg in 57 (65.5%) in the non-skin lesion group (p = 0.26). Median PPI scores at hospital admission were 4.5 versus 6.5 (p = 0.08). Median survival was 23 versus 21 days (p = 0.48). Conclusion: Patients with skin lesions had a distinct symptom burden and tended to use a higher dose of opioids. The effect of skin lesions on survival was unclear. 

/pdf/symptoms-and-prognoses-of-patients-with-end-stage-fungating-4ph8hqbo.pdf

Symptoms and prognoses of patients with end-stage fungating breast cancer in palliative care units: the multicentre, prospective, observational EASED study

Fungating and Ulcerating Breast Cancer: Wound Closure Algorithm, Complications, and Survival Trends

Locally advanced, fungating breast cancer is a distressing condition that is frequently seen worldwide. Radiation is particularly useful in reducing the associated symptoms such as discharge, bleeding and pain. However, there is surprisingly limited data regarding the efficacy of radiation in controlling symptoms in patients with this condition. Records of 35 patients with fungating breast cancer were retrospectively reviewed. Study end points included tumor and symptom response (including response rates, duration of response), median survival, and treatment toxicity, which was scored using the Common Toxicity Criteria v3.0. To investigate for a dose-response relationship, patients were divided into two subgroups using the median biological effective dose (BED) of radiation. Patients in the higher BED subgroup (40 Gy10 or greater) were compared to those in the lower BED group (less than 40 Gy10) using the Fisher’s exact test. Median age was 59 years (range 40–91 years). Thirty-two patients (91 %) had tumor size larger than 5 cm and nine patients (26 %) had known distant metastatic disease at the time of treatment. Dose-fractionation regimen ranged from 20 Gy in 5 fractions to 65 Gy in 26 fractions. Median survival was 11.7 months. Actuarial 12-month survival was 58 %. There was no difference between the high-dose and the low-dose groups, and higher radiation dose was not found to be associated with a longer duration of palliation or survival. No patients experienced grade 3 or 4 toxicity. Radiotherapy is effective palliative treatment for patients with fungating breast cancer. High response rates of up to 90 % can be expected, with a median local progression-free survival of 10 months. With the advent of dose escalation techniques such as intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), it is now technically possible to deliver high radiation doses to patients with low toxicity and risk to the adjacent normal organs. Nevertheless, whether higher doses or longer courses of radiotherapy confer better local control is a potential subject for further study.

Clinical outcomes of fungating breast cancer treated with palliative radiotherapy

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Clinical outcomes of fungating breast cancer treated with palliative radiotherapy