Application of conformal radiotherapy for multimodality treatment of primary inoperable locally advanced breast cancer. Clinical case

«Radiation and Risk», 2020, vol. 29, No. 3, pp.79-87

DOI: 10.21870/0131-3878-2020-29-3-79-87

Authors

Saribekyan E.K. – Sen. Researcher, MD
Medvedev S.V. – Sen. Researcher, C. Sc., Med.
Vlasova M.Yu. – Physician, Postgraduate of First Moscow SMU. Contacts: 3, 2 Botkynski proesd, Moscow, Russia, 125284. Tel.: 8-985-071-84-78; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Ablitsova N.V. – Physician, C. Sc., Med.
Mitelman L.Yu. – Physician
Kupriyanov P.I. – Physician, Postgraduate of First Moscow SMU. P.A. Hertsen MORC.

¹ P.A. Hertsen MORC – branch of FSBI NMRRC of the Ministry Health of Russia, Moscow
² First Moscow State Medical University, Ministry of Health of Russia, Moscow

Abstract

Locally advanced breast cancer is one of the malignant neoplasms of the breast with poor progno-sis for treatment. However, the multimodality treatment of the disease and the following rehabilitation result in favorable outcomes. The treatment plan consists of pre-operative drug therapy, loco-regional surgery and/or radiation therapy in the course of adjuvant chemotherapy. It is important to stress that preoperative (Induction) chemoradiation therapy makes possible the following surgery. Currently, induction radiation therapy is recommended if neoadjuvant therapy is insufficient and surgery at the second stage of the treatment is impossible. In the article the authors review previously published features of complex treatment of locally advanced breast cancer. They also present clinical case report with details of the treatment of inoperable primary locally advanced breast cancer. The patient K., 73 y.o, found herself the tumor in the left breast in 04.2017, she did not visit a doctor. In 18 month she visited a doctor for the first time, the tumor size increased, exophytic component was formed in the parasternal region at the left. Clinical diagnosis was established: left breast gland cancer, stage III, cT4bN1M0, G3, luminal type B, Her2-negative subetype (estrogene receptors – 5 balls progesterone receptors – 8 balls, Her2/neu – negative expression, Ki67 – 70%). Induction chemoradiation therapy (capecitabine + conformal radiotherapy with total radiation dose to the target – 60 Gy) followed ineffective hormonal therapy resulted in complete reabsorption of huge exophytic ulcerous tumor, the next modality was radical mastectomy followed by the remis-sion in the course of adjuvant hormonal therapy. If a tumor is radiosensitive, radiotherapy effect is pronounced, tumor becomes operable and the following treatment plan can be implemented on a full scale. That gives a favorable chance for future health life.

Key words
breast cancer, locally advanced breast cancer, conformal radiation therapy, induction therapy, combined chemoradiotherapy, preoperative radiation therapy, neoadjuvant therapy for locally advanced breast cancer, multimodality treatment, inoperable tumor, exophytic tumor.

References

1. Malignant neoplasms in Russia in 2018 (morbidity and mortality). Eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow, Р. Hertsen MORI, 2019. 250 p. (In Russian).

2. The status of cancer care for the population in Russia in 2018. Eds.: A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow, NMRRC, 2019. 236 p. (In Russian).

3. Al-Hilli Z., Boughey J.C. The timing of breast and axillary surgery after neoadjuvant chemotherapy for breast cancer. Chin. Clin. Oncol., 2016, vol. 5, no. 3, pp. 37-47. DOI: 10.21037/cco.2016.03.26.

4. Yee C., Alayed Y., Drost L., Karam I., Vesprini D., McCann C., Soliman H., Zhang L., Chow E., Chan S., Lee J. Radiotherapy for patients with unresected locally advanced breast cancer. Ann. Palliat. Med., 2018, vol. 7, no. 4, pp. 373-384.

5. Demidov S.M., Petkau V.V., Lan S.A. Results of treatment of patients with locally advanced breast cancer. Professional'nye kantserogeny i rak – Occupational Carcinogens and Cancer, 2008, vol. 51, no. 11, pp. 98. (In Russian).

6. Stenina M.B., Zhukova L.G., Koroleva I.A., Parokonnaya A.A., Semiglazova T.Yu., Tyulyandin S.A., Frolova M.A. Practical recommendations for drug treatment of invasive breast cancer. Malignant tumors:practical recommendations of RUSSCO. Moscow, Fond «Onkoprogress», 2019, vol. 9, no. 3s2, pp. 128-163. (In Russian).

7. Lyadov V.K., Skrypnikova M.A., Popova O.P. Isolation of tumor cells circulating in the blood by the method of "isolation by size (ISET)" (review). Voprosy onkologii – Questions of Oncology, 2014, vol. 60, no. 5, pp. 548-552. (In Russian).

8. Portnoj S.M. The role of the surgical method in the treatment of locally advanced and disseminated breast cancer. Prakticheskaya onkologiya – Practical Oncology, 2000, vol. 1, no. 2, pp. 57-60. (In Russian).

9. Hakimov G.A., Shayusupov N.R., Miryusupova G.F. Experience in treating patients with locally advanced breast cancer. Opukholi zhenskoj reproduktivnoj sistemy – Tumors of the Female Reproductive System, 2009, vol. 2, no. 1, pp. 27-29. (In Russian).

10. Matuschek C., Nestle-Kraemling C., Haussmann J. Long-term cosmetic outcome after preoperative radio-chemotherapy in locally advanced breast cancer patients. Strahlentherapie und Onkologie, 2019, vol. 195, no. 7, pp. 615-628.

11. Kaidar-Person O., Kuten A., Belkacemi Y. Primary systemic therapy and whole breast irradiation for locally advanced breast cancer: a systematic review. Crit. Rev. Oncol./Hematol., 2014, vol. 92, no. 2, pp. 143-152.

12. Roth S.L., Audretsch W., Bojar H., Lang I., Willers R., Budach W. Retrospective study of neoadjuvant versus adjuvant radiochemotherapy in locally advanced noninflammatory breast cancer. Strahlentherapie und Onkologie, 2010, vol. 186, no. 6, pp. 299-306.

13. Artamonova E.V. General principles of drug treatment of primary operable and locally advanced breast cancer. Opukholi zhenskoj reproduktivnoj sistemy – Tumors of the Female Reproductive System, 2014, vol. 4, no. 3, pp. 29-33. (In Russian).

14. Slonimskaya E.M., Musabaeva L.I., Lisin V.A., Shagiahmetova R., Zhogina Zh.A. Complex therapy of locally advanced breast cancer using neutron-photon therapy. Sibirskij onkologicheskij zhurnal – Siberian Journal of Oncology, 2002, no. 2, pp. 21-26. (In Russian).

15. Giuliano A.E., Connolly J.L., Edge S.B., Mittendorf E.A., Rugo H.S., Solin L.J., Weaver D.L., Winchester D.J., Hortobagyi G.N. Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J. Clin., 2017, vol. 67, no. 4, pp. 290-303.

16. Singh P., Hoffman K., Schaverien M.V. Neoadjuvant radiotherapy to facilitate immediate breast reconstruction: a systematic review and current clinical trials. Ann. Surg. Oncol., 2019, vol. 26, no. 10, pp. 3312-3314.

Full-text article (in Russian)