Palliative High-Dose Radiotherapy for Ulcerative Breast Lesions

Abstract

<h3>Purpose/Objective(s)</h3> Breast cancer with skin invasion may cause decreased quality of life due to bleeding, self-destruction, and pain. However, there is no consensus on the optimal dose for palliative irradiation. In this study, we investigated the efficacy and safety of relatively high-dose treatment to sustain tumor control and symptom relief in patients with long-term survival expectations. <h3>Materials/Methods</h3> Between June 2013 to April 2021, a total of 32 patients who received relatively high-dose palliative irradiation for breast cancer with skin invasion at our institution were selected. Radiotherapy was performed at a total dose of 45-70 Gy with 2-3 Gy per fraction. (45 Gy/15 Fr:1, 50 Gy/20 Fr:3, 54 Gy/18Fr:1, 60 Gy/24 Fr:4, 60 Gy/20 Fr:19, 60 Gy/30 Fr:2, 70 Gy/35 Fr:2) We retrospectively analyzed the efficacy of local control, symptomatic relief, and adverse events. <h3>Results</h3> Median follow-up was 9.0months (range:2.6-69.6months). The median age was 65years (range: 36-89years), 27 cases (84%) had distant metastasis at the time of radiotherapy. After radiotherapy, 29 cases (91%) had symptomatic relief of bleeding, discharge, or pain. Of the 30 cases in which CT was taken, 28 cases (93%) showed tumor reduction, of which 6 cases showed subsequent re-growth. The median duration of local control was 4.9months (range: 1.23-68.87months), and the 6-month local control rate was 86.9%, 12-month local control rate was 68.3%, and 24-month local control rate was 60.7%. Acute adverse events included dermatitis in G3/G2/G1 = 13/14/5 cases (40/44/16%), and late adverse events included pneumonitis in G2/G1 = 1/15 cases (3/47%). No other late adverse events above G3 were observed. <h3>Conclusion</h3> The local control and symptom relief of relatively high-dose therapy are favorable. The frequency of late adverse events, such as pneumonitis, is within an acceptable range. Further investigation on prescription dose and safety is required.