Clinical outcomes of fungating breast cancer treated with palliative radiotherapy

Abstract

Purpose

Locally advanced, fungating breast cancer is a distressing condition that is frequently seen worldwide. Radiation is particularly useful in reducing the associated symptoms such as discharge, bleeding and pain. However, there is surprisingly limited data regarding the efficacy of radiation in controlling symptoms in patients with this condition.

Methods and materials

Records of 35 patients with fungating breast cancer were retrospectively reviewed. Study end points included tumor and symptom response (including response rates, duration of response), median survival, and treatment toxicity, which was scored using the Common Toxicity Criteria v3.0. To investigate for a dose-response relationship, patients were divided into two subgroups using the median biological effective dose (BED) of radiation. Patients in the higher BED subgroup (40 Gy₁₀ or greater) were compared to those in the lower BED group (less than 40 Gy₁₀) using the Fisher’s exact test.

Results

Median age was 59 years (range 40–91 years). Thirty-two patients (91 %) had tumor size larger than 5 cm and nine patients (26 %) had known distant metastatic disease at the time of treatment. Dose-fractionation regimen ranged from 20 Gy in 5 fractions to 65 Gy in 26 fractions. Median survival was 11.7 months. Actuarial 12-month survival was 58 %. There was no difference between the high-dose and the low-dose groups, and higher radiation dose was not found to be associated with a longer duration of palliation or survival. No patients experienced grade 3 or 4 toxicity.

Conclusion

Radiotherapy is effective palliative treatment for patients with fungating breast cancer. High response rates of up to 90 % can be expected, with a median local progression-free survival of 10 months. With the advent of dose escalation techniques such as intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), it is now technically possible to deliver high radiation doses to patients with low toxicity and risk to the adjacent normal organs. Nevertheless, whether higher doses or longer courses of radiotherapy confer better local control is a potential subject for further study.