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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 @Laura Warren and @Jennifer R. Bellon reviewing landscape of adjuvant treatment after lumpectomy for DCIS, and companion study with longterm outcomes from RTOG 9804 (@Beryl McCormick et al).
Answer from: Radiation Oncologist at Community Practice
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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Answer from: Radiation Oncologist at Academic Institution
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.
Comments
Radiation Oncologist at St. Johns Health Center
Not sure I see the rationale for hypofractionation...
Not sure I see the rationale for hypofractionation...
Radiation Oncologist at Cleveland Clinic
Given the previous RT, I have tended to use this a...
Given the previous RT, I have tended to use this a...
Radiation Oncologist at Spectrum Health-Butterworth Campus
Thanks for the helpful and informative responses. ...
Thanks for the helpful and informative responses. ...
Radiation Oncologist at Rush University Medical Center
I agree with conventional and hyper fractionation....
I agree with conventional and hyper fractionation....