Intensity modulated radiotherapy and targeted therapy for late nonregional para-aortic lymph node metastasis from HER2 positive breast carcinoma

Abstract

In the case of invasive breast carcinomas (BC) there are extremely rare late nonregional retroperitoneal lymph node recurrences, occurring after 10 years of disease diagnosis. We present a 32-year-old woman, who was diagnosed in 2010 with left HER2 positive invasive ductal BC- pT2N1M0. Complex treatment involving radical mastectomy with axillary dissection and complex adjuvant treatment (chemotherapy, radiotherapy, targeted therapy with trastuzumab, endocrine therapy with LHRH agonist plus tamoxifen) was conducted. After 4 years, disease progression with left supraclavicular lymph node enlargement has been manifested. After surgical resection of supraclavicular lymph node, the patohistological analysis establishes lymph metastasis from HER2 positive invasive ductal carcinoma. After 6 years of multimodal treatment, including eight chemotherapy cycles docetaxel, bilateral adnexectomy, 2 targeted agents trastuzumab/pertuzumab and endocrine therapy with aromatase inhibitor, PET/ CT visualizes a nonregional lymph recurrence of left retroperitoneal lymph nodes. Isolated involvement of distant nodal regions is extremely uncommon. Complex therapy, including a definitive radiotherapy of retroperitoneal para-aortic lymph nodes combined with targeted therapy achieved complete remission in nonregional abdominal lymph recurrence.