Efficacy of Hyperthermia in Treatment of Recurrent Metastatic Breast Cancer After Long-Term Chemotherapy: A Report of 2 Cases

Abstract

BACKGROUND Breast cancer has a long-term prognosis with various multimodality treatments. This report introduces the effectiveness of radiofrequency (RF) hyperthermia in the long-term treatment for recurrent/metastatic breast cancer. CASE REPORT In the first case, the patient had bone and liver metastases during the course of chemotherapy, hormone therapy, and radiotherapy for 27 years after curative resection of breast cancer. Finally, she received RF hyperthermia alone for liver metastasis and showed a decrease in tumor markers and reduction in liver metastasis on computed tomography (CT). In the second case, the patient underwent curative resection for multiple occurrences on the left side of the breast. She received postoperative chemotherapy combined with hormone therapy but had metachronous local recurrences. She continued hormone therapy after 2 local recurrence resections; unfortunately, she had bone, liver, and lung metastases and pleural dissemination. Eventually, the patient received RF hyperthermia combined with oral chemotherapy. Her tumor markers decreased, and CT showed disappearance of lung metastasis and improved pleural dissemination. Furthermore, the reduction of chemotherapy adverse events due to hyperthermia allowed the patient to continue chemotherapy and improved her quality of life. CONCLUSIONS We present 2 cases in which RF hyperthermia had a positive effect despite the presence of a recurrent tumor after various types of surgery, chemotherapy, and radiotherapy. This report suggests that the addition of RF hyperthermia to conventional multidisciplinary therapies may enhance the therapeutic effect of these treatments and improve the quality of life in patients with recurrent breast cancer.

Figure 1.

Detailed clinical history and notable trend of tumor markers since October 2018 in Case 1. AI – aromatase inhibitor; EC – epirubicin hydrochloride+cyclophosphamide hydrate; EM – eribulin mesylate; MA – medroxyprogesterone acetate; Rad – radiation therapy; RF-HT – radiofrequency hyperthermia; TAM – tamoxifen; TC – docetaxel hydrate+cyclophosphamide hydrate; CEA – carcinoembryonic antigen (<5.0 ng/mL); CA15-3 – cancer antigen 15-3 (<25 U/mL).

Figure 2.

Changes in liver metastasis on enhanced computed tomography (E-CT) and ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) imaging. Liver metastasis (white arrowhead) found on E-CT 16 years and 10 months after surgery (A) were recognized as space-occupying lesions (white arrowhead) on E-CT 2 years later (B). ¹⁸F-FDG PET/CT showed no abnormal accumulation (white arrowhead) in that area (C).

Figure 3.

Changes in bone metastasis on ¹⁸F-FDG-PET/CT imaging, magnetic resonance imaging (MRI), and bone scintigraphy. ¹⁸F-FDG-PET/CT (A) and MRI (B) revealed bone metastasis in the 3^rd lumbar vertebra (white arrowhead) in December 2014. Three years and 10 months later, ¹⁸F-FDG-PET/CT (C) showed no abnormal accumulation in the 3^rd lumbar vertebra (white arrowhead). Bone scintigraphy in June 2019 showed no abnormal accumulation in the 3^rd lumbar vertebra and no other bone metastases (D).

Figure 4.

Changes in newly developed liver metastasis on E-CT imaging. Twenty-five years after surgery, E-CT (A) revealed newly developed liver metastasis (white arrowhead). E-CT after administration of eribulin mesylate for 8 months showed no reduction in liver metastasis (B). E-CT images after receiving 30 cycles of RF hyperthermia (C) (white arrowheads) showed liver metastasis that gradually reduced.

Figure 5.

Detailed clinical history and the notable trend of tumor markers since January 2019 in Case 2. AI – aromatase inhibitor; Bv – bevacizumab; EC – epirubicin hydrochloride+cyclophosphamide hydrate; EM – eribulin mesylate; FUL – fulvestrant; GEM – gemcitabine; PTX – paclitaxel; RF-HT – radiofrequency hyperthermia; TAM – tamoxifen; XC – capecitabine+cyclophosphamide hydrate; CEA – carcinoembryonic antigen (<5.0 ng/mL); CA15-3 – cancer antigen 15-3 (<25 U/mL).

Figure 6.

Primary breast cancer and recurrent lesions on E-CT imaging. E-CT on July 2007 (A) showed the primary breast cancer (white arrowhead). E-CT at 3 years and 8 months (B) and 4 years and 4 months (C) after the first surgery revealed the recurrent lesions (white arrowheads) in the left chest wall.

Figure 7.

Changes in liver metastasis on E-CT and bone metastasis on bone scintigraphy. E-CT 6 years and 9 months after the first surgery (A) revealed liver metastasis (white arrowhead). Six months later, E-CT (B) showed the enlargement of liver metastasis (white arrowhead), and bone scintigraphy (C) showed bone metastasis in right 6^th rib (black arrow). After 2 years and one month with oral S-1 chemotherapy, both liver and bone metastases disappeared on CT (D) and bone scintigraphy (E).

Figure 8.

Changes in the pleural effusion, pleural thickening, and lung metastasis on CT. E-CT in May 2017 (A) showed the pleural effusion (white arrowhead) and pleural thickening (white arrow). E-CT 5 months later (B) revealed disappearance of pleural effusion and pleural thickening. On CT in January 2019 (C), left pleural effusion was observed again (black arrowhead) and a nodular shadow appeared in the lingular division of the left lung (black arrow). CT in September 2019 (D) revealed increased pleural effusion (black arrowhead) and an enlarged nodular shadow (black arrow). E-CT performed after receiving of RF hyperthermia (E) showed disappearance of lung metastasis (black arrows) and decrease in pleural effusion (black arrowheads).