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. 2023 Jan-Dec:22:15330338231164537.
doi: 10.1177/15330338231164537.

Palliative Radiotherapy for Symptomatic Locally Advanced Breast Cancer

Line Hoeltgen  1   2   3 , Eva Meixner  1   2   3 , Philipp Hoegen  1   2   3   4 , Elisabetta Sandrini  1   2   3 , Fabian Weykamp  1   2   3   4 , Tobias Forster  1   2   3 , Maria Vinsensia  1   2   3 , Kristin Lang  1   2   3 , Laila König  1   2   3 , Nathalie Arians  1   2   3 , Carlo Fremd  3 , Laura L Michel  3 , Katharina Smetanay  3   5 , Andreas Schneeweiss  3 , Markus Wallwiener  5 , Jürgen Debus  1   2   3   4   6   7 , Juliane Hörner-Rieber  1   2   3   4
Affiliations

Palliative Radiotherapy for Symptomatic Locally Advanced Breast Cancer

Line Hoeltgen et al. Technol Cancer Res Treat. 2023 Jan-Dec.

Abstract

Objective: Women with locally advanced breast cancer (LABC) or inoperable local recurrence often suffer from a significantly reduced quality of life (QOL) due to local tumor-associated pain, bleeding, exulceration, or malodorous discharge. We aimed to further investigate the benefit of radiotherapy (RT) for symptom relief while weighing the side-effects. Materials and methods: Patients who received symptom-oriented RT for palliative therapy of their LABC or local recurrence in the Department of Radiation Oncology at Heidelberg University Hospital between 2012 and 2021 were recorded. Clinical, pathological, and therapeutic data were collected and the oncological and symptomatic responses as well as therapy-associated toxicities were analyzed. Results: We retrospectively identified 26 consecutive women who received palliative RT with a median total dose of 39 Gy or single dose of 3 Gy in 13 fractions due to (impending) exulceration, pain, local hemorrhage, and/or vascular or plexus compression. With a median follow-up of 6.5 months after initiation of RT, overall survival at 6 and 12 months was 60.0% and 31.7%, and local control was 75.0% and 47.6%, respectively. Radiation had to be discontinued in 4 patients due to oncological clinical deterioration or death. When completed as initially planned, symptom improvement was achieved in 95% and WHO level reduction of analgesics in 28.6% of patients. In 36% (16%) of patients, local RT had already been indicated >3 months (>6 months) before the actual start of RT, but was delayed or not initiated among others in favor of drug alternatives or systemic therapies. RT-associated toxicities included only low-grade side-effects (CTCAE I°-II°) with predominantly skin erythema and fatigue even in the context of re-RT. Conclusion: Palliative RT in symptomatic LABC or locoregional recurrence is an effective treatment option for controlling local symptoms with only mild toxicity. It may thus improve QOL and should be considered early in palliative patient care management.

Keywords: LABC; exulceration; hemorrhage; pain; palliative care; radiation therapy.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: F.W. received speaker fees from AstraZeneca and Merck Sharp & Dohme outside the submitted work. M.W. received speaker fees from Novartis, Roche, MSD and Grants from Celgene outside the submitted work. J.D. received grants from CRI—The Clinical Research Institute GmbH, Accuray Incorporated, Accuray International Sàrl, RaySearch Laboratories AB, Vision RT limited, Astellas Pharma GmbH, Astra Zeneca GmbH, Solution Akademie GmbH, Ergomed PLC Surrey Research Park, Merck Serono GmbH, Siemens Healthcare GmbH, Quintiles GmbH, Pharmaceutecal Research Associates GmbH, Boehringer Ingelheim Pharma GmbH Co, PTW-Freiburg Dr. Pychlau GmbH, Nanobiotix A.A., IntraOP Medical and Varian Medical Systems outside the submitted work. J.HR. received speaker fees from ViewRay Inc. and Pfizer Inc., travel reimbursement from ViewRay Inc., IntraOP Medical and Elekta Instrument AB as well as grants from IntraOP Medical and Varian Medical Systems outside the submitted work.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves for local control rate (A) and overall survival rate (B).
Figure 2.
Figure 2.
Exulcerating locally advanced breast carcinoma before (A) and after (B) palliative radiotherapy with 39 Gy in 3 Gy per fraction.
See this image and copyright information in PMC

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