A clinical case of treatment of recurrent inoperable locally advanced breast cancer using conformal radiotherapy. Case report

Cover Page

Cite item

Full Text

Abstract

Despite advances in the early diagnosis of breast cancer (BC), the identification of locally advanced forms continues to be relevant. This is a complex category of patients whose treatment includes the complex use of various methods with significant medical and economic costs, long-term treatment and rehabilitation. A particular difficulty is the treatment in cases of progression of locally advanced forms. Patients with locally advanced BC require a multidisciplinary approach. In the absence of an effect after neoadjuvant drug treatment and the impossibility of performing surgical intervention, patients are treated with induction radiation therapy. The article describes the features of induction radiation therapy in the treatment of progression of primary inoperable BC in a specific clinical example. In case of recurrence of triple negative type of BC, the patient underwent various drug treatment regimens with the inclusion of immunotherapy. Due to the lack of effect from 3 lines of systemic drug treatment, it was decided to conduct radiation therapy. In connection with the identified carrier of a mutation in the BRCA1 gene, targeted therapy with PARP inhibitors was prescribed. Two months after radiation therapy and 1 month after the start of targeted therapy, the patient showed complete resorption of the tumor conglomerate on the anterior chest wall. The use of conformal radiation therapy in case of recurrence of the disease and the absence of the effect of systemic treatment made it possible to completely resorb an exophytic tumor with ulceration and achieve remission within the next 6 months.

About the authors

Sergey V. Medvedev

National Medical Research Radiological

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0002-6057-1230

Cand. Sci. (Med.), Hertsen Moscow Scientific Researh Institute of Oncology

Russian Federation, Moscow

Maria Yu. Vlasova

National Medical Research Radiological

Author for correspondence.
Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0001-7502-2288

Cand. Sci. (Med.), Hertsen Moscow Scientific Researh Institute of Oncology 

Russian Federation, Moscow

Larisa V. Bolotina

National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0003-4879-2687

D. Sci. (Med.), Hertsen

Russian Federation, Moscow

Andrey D. Kaprin

National Medical Research Radiological Centre; Patrice Lumumba People’s Friendship University of Russia; National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0001-8784-8415

D. Sci. (Med.), Prof., Acad. RAS, Hertsen Moscow Scientific Researh Institute of Oncology

Russian Federation, Moscow; Moscow; Moscow

Evgeny V. Khmelevskiy

National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0002-4880-0213

D. Sci. (Med.), Prof., Hertsen Moscow Scientific Researh Institute of Oncology 

Russian Federation, Moscow

Aziz D. Zikiryakhodzhaev

National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0001-7141-2502

D. Sci. (Med.), Prof., Hertsen Moscow Scientific Researh Institute of Oncology

Russian Federation, Moscow

Shakhnoz G. Khakimova

Patrice Lumumba People’s Friendship University of Russia; Tashkent Pediatric Medical Institute

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0002-9491-0413

Cand. Sci. (Med.)

Uzbekistan, Moscow; Tashkent

Gulnoz G. Khakimova

Tashkent Pediatric Medical Institute

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0002-4970-5429

Cand. Sci. (Med.)

Uzbekistan, Tashkent

Natalya M. Bychkova

National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0002-5177-2612

Cand. Sci. (Med.), Hertsen Moscow Scientific Researh Institute of Oncology 

Russian Federation, Moscow

Natalia A. Zaitseva

Hertsen Moscow Scientific Researh Institute of Oncology

Email: vlasova_maria2092@mail.ru
ORCID iD: 0000-0002-2764-5189

Department Head, National Medical Research Radiological 

Russian Federation, Moscow

Elnara R. Abushova

National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0009-0009-9836-1261

radiotherapist, Hertsen Moscow Scientific Researh Institute of Oncology 

Russian Federation, Moscow

Svetlana D. Guseva

National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0009-0006-2117-9865

Graduate Student, Hertsen Moscow Scientific Researh Institute of Oncology 

Russian Federation, Moscow

Egor D. Maslov

National Medical Research Radiological Centre

Email: vlasova_maria2092@mail.ru
ORCID iD: 0009-0001-0084-6124

Resident, Hertsen Moscow Scientific Researh Institute of Oncology 

Russian Federation, Moscow

References

  1. Злокачественные новообразования в России в 2020 году (заболеваемость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой. М.: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2021 [Zlokachestvennyie novoobrazovaniia v Rossii v 2020 godu (zabolevaiemost' i smertnost'). Pod red. AD Kaprina, VV Starinskogo, GV Petrovoi. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2021 (in Russian)].
  2. Состояние онкологической помощи населению России в 2023 году. Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2022 [Sostoianiie onkologicheskoi pomoshchi naseleniiu Rossii v 2023 godu. Pod red. AD Kaprina, VV Starinskogo, AO Shakhzadovoi. Moscow: MNIOI im. P.A. Gertsena − filial FGBU “NMITS radiologii“ Minzdrava Rossii, 2022 (in Russian)].
  3. National Comprehensive Cancer Network. Breast cancer (version 3.2021). 2021. Available at: https://www.nccn.org/professionals/physician_gls/pdf/ Acccessed: 12.12.2023.
  4. Franceschini G, Terribile D, Fabbri C, et al. Management of locally advanced breast cancer. Mini-review. Minerva Chirurgica. 2007;62(4):249-55.
  5. Сарибекян Э.К., Медведев С.В., Власова М.Ю., и др. Клинический случай комплексного лечения первично-неоперабельного местно-распространенного рака молочной железы с применением конформной лучевой терапии. Радиация и риск. 2020;29(3):79-87 [Saribekyan EK, Medvedev SV, Vlasova MYU, et al. Klinicheskii sluchai kompleksnogo lecheniia pervichno-neoperabel'nogo mestno-rasprostranennogo raka molochnoi zhelezy s primeneniiem konformnoi luchevoi terapii. Radiatsiia i Risk. 2020;29(3):79-87 (in Russian)]. doi: 10.21870/0131-3878-2020-29-3-79-87
  6. Curigliano G, Criscitiello C, Esposito A, et al. Best management of locally advanced inoperable breast cancer. Eur J Cancer. 2013;11(2):289-90. doi: 10.1016/j.ejcsup.2013.07.052
  7. 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;92(2):143-52. doi: 10.1016/j.critrevonc.2014.04.005
  8. 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;195(7):615-28. doi: 10.1007/s00066-019-01473-2
  9. Roth SL, Audretsch W, Bojar H, et al. Retrospective study of neoadjuvant versus adjuvant radiochemotherapy in locally advanced noninflammatory breast cancer: survival advantage in cT2 category by neoadjuvant radiochemotherapy. Strahlentherapie Und Onkologie. 2010;186(6):299-306. doi: 10.1007/s00066-010-2143-0
  10. Артамонова Е.В. Общие принципы лекарственного лечения первично-операбельного и местно-распространенного рака молочной железы. Опухоли женской репродуктивной системы. 2009;(3-4):29-33 [Artamonova EV. General principles of drug treatment for primary operable and locally advanced breast cancer. Tumors of Female Reproductive System. 2009;(3-4):29-33 (in Russian)].
  11. Портной С.М. Роль хирургического метода в лечении местно-распространенного и диссеминированного рака молочной железы. Практическая онкология. 2000;1(2):57-60 [Portnoi SM. Rol' khirurgicheskogo metoda v lechenii mestnorasprostranennogo i disseminirovannogo raka molochnoi zhelezy. Prakticheskaia Onkologiia. 2000;1(2):57-60 (in Russian)].
  12. Хакимов Г.А., Шаюсупов Н.Р., Мирюсупова Г.Ф. Опыт лечения больных местно-распространенным раком молочной железы. Опухоли женской репродуктивной системы. 2009;1(2):27-9 [Khakimov GA, Shayusupov NR, Miryusupova GF. Experience in treating patients with locally advanced breast cancer. Tumors of Female Reproductive System. 2009;1(2):27-9 (in Russian)].
  13. Хмелевский Е.В. Современная лучевая терапия в лечении местно-распространенного и рецидивирующего рака молочной железы: автореф. дис. … д-ра мед. наук. М., 1997; с. 34 [Khmelevskii EV. Sovremennaia luchevaia terapiia v lechenii mestno-rasprostranennogo i retsidiviruiushchego raka molochnoi zhelezy: avtoref. dis. … d-ra med. nauk. Moscow, 1997; p. 34 (in Russian)].
  14. Слонимская Е., Мусабаева Л., Жогина Ж. Комплексная терапия местно-распространенного рака молочной железы с применением нейтронно-фотонной терапии. Сибирский онкологический журнал. 2002;2:21-6 [Slonimskaia E, Musabaieva L, Zhogina ZH. Kompleksnaia terapiia mestno-rasprostranennogo raka molochnoi zhelezy s primeneniiem neytronno-fotonnoi terapii. Sibirskii Onkologicheskii Zhurnal. 2002;2:21-26 (in Russian)].
  15. Mladenovic J, Susnjar S, Tanic M, et al. Tumor response and patient outcome after preoperative radiotherapy in locally advanced non-inflammatory breast cancer patients. J BUON. 2017;22(2):325-33.
  16. Aebi S, Karlsson P, Wapnir IL. Locally advanced breast cancer. Breast. 2022;62 Suppl. 1(Suppl. 1):S58-62. doi: 10.1016/j.breast.2021.12.011
  17. Mittendorf EA, Zhang H, Barrios CH, et al. Neoadjuvant atezolizumab in combination with sequential nab-paclitaxel and anthracycline-based chemotherapy versus placebo and chemotherapy in patients with early-stage triple-negative breast cancer (IMpassion031): a randomised, double-blind, phase 3 trial. Lancet. 2020;396(10257):1090-100.
  18. Matuschek C, Bölke E, Roth S, et al. Long-term outcome after neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer and predictive factors for a pathologic complete remission. Strahlenther Onkol. 2012;188:777-81.
  19. Xu Yu, Hu X, Zhou L, at al. Effect of sequencing of preoperative systemic therapy on patients with locally advanced breast cancer. Breast J. 2020;26(10):1987-94. doi: 10.1111/tbj.14017

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. PET-CT, horizontal view dated May 2022 before the beginning of treatment. View of the chest wall at the level of the ThIV vertebra.

Download (88KB)
Indexing metadata
3. Fig. 2. Type of tumor lesion before the start of radiation therapy (RT).

Download (215KB)
Indexing metadata
4. Fig. 3. Dose distribution in the irradiation volume (95% and 80% of the isodose curve are indicated in percentage).

Download (180KB)
Indexing metadata
5. Fig. 4. CT scan of the chest after RT. The dimensions of the tumor nodes are indicated by green lines: a – view of the chest wall at the level of the ThV vertebra; b – view of the chest wall at the level of the ThIII vertebra.

Download (155KB)
Indexing metadata
6. Fig. 5. View of the patient: a – after completion of the RT course; b – 2 months after RT and 1 month after the start of targeted therapy.

Download (134KB)
Indexing metadata
7. Fig. 6. Metastatic lymph node in the right axillary region according to PET-CT dated November 2022.

Download (70KB)
Indexing metadata
8. Fig. 7. Dose distribution in the irradiation area. The red line indicates the GTV target – the lymph node in the right axillary region; the green line indicates CTV at a distance of 10 mm from GTV; and the yellow line indicates PTV with a craniocaudal distance of 12 mm and 10 mm in all other directions from CTV, taking into account the boundaries of critical structures.

Download (129KB)
Indexing metadata
9. Fig. 8. PET-CT dated 07.03.2023, 3 months after completion of RT; complete regression of the metastatic lymph node in the right axillary region.

Download (64KB)
Indexing metadata

Copyright (c) 2025 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 


Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).