Concomitant fulvestrant with reirradiation for unresectable locoregional recurrent estrogen receptor positive (ER+) breast cancer

Abstract

Rationale: Locoregional recurrence of breast cancer is a challenging issue for clinicians. Treatment options for unresectable recurrent estrogen receptor positive (ER+) breast cancer in previously irradiated area are limited. Some studies showed concomitant fulvestrant with radiation therapy might increase radiosensitivity compared with radiation alone in vitro, no in vivo reports yet. Patient concern: Here, we present a case report and make a narrative review of concomitant fulvestrant with radiation therapy for unresectable locoregional recurrent ER+ breast cancer. The patient was treated with modified radical mastectomy in 2015, adjuvant chemotherapy, radiotherapy, followed by exemestane until November 2018, relapsed in internal mammary lymph nodes with sternum involved. Diagnosis: The final diagnosis was breast cancer internal mammary lymph nodes metastasis with sternum involved. Interventions: After diagnosis was made, concurrent fulvestrant with reirradiation as a palliative treatment were proposed under multiple disciplinary team. Outcomes: There was a good clinical response, enabling curative chance with radiation therapy to a total dose of 60 Gy. Computed tomography scan revealed no evidence of residual tumor. Lessons: As far as we know, this is the first report concerning concomitant fulvestrant with reirradiation for unresectable locoregional recurrent ER+ breast cancer. Since no severe adverse events were observed, this strategy could be a suitable “loco-regional rescue therapy” to further reduce tumor progression or even reach a curative effect. Studies of this treatment strategy in randomized clinical trials are warranted to further assess its safety and effectiveness.

Efficacy, Safety, and Prognosis of Sequential Therapy with Tamoxifen and Letrozole versus Letrozole Monotherapy for Breast Carcinoma

“…According to epidemiological data, there are approximately 2.3 million new cases of BC and 685,000 deaths worldwide [ 2 ]. With the constant optimization of BC screening methods and treatments in recent years, its recurrence rate and mortality rate have been declining, with a 5-year overall survival rate even over 90% in some countries [ 3 ]. However, once BC has metastasized, the average 5-year survival rate is as low as 22%, with certain risk of recurrence [ 4 ].…”

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

“…Breast cancer is often described in relationship with secondary osseous sites; however, sternal involvement remains rather unusual, especially as a single lesion [ 15 , 16 , 17 ]. While metastatic breast cancer is a frequent condition, oligo-metastatic disease, particularly to the sternum, is unusual, with the first such report dating back to 1988 [ 18 ].…”

“…Overall, we identified 14 studies (of more than 1 subject/article) [ 18 , 20 , 21 , 22 , 24 , 51 , 53 , 64 , 66 , 70 , 72 , 73 , 74 , 75 ] and 34 single case reports [ 14 , 15 , 16 , 17 , 19 , 23 , 25 , 26 , 38 , 41 , 42 , 43 , 47 , 52 , 55 , 56 , 59 , 60 , 62 , 68 , 71 , 76 , 77 , 78 , 89 , 98 , 99 , 100 , 101 , 102 ] within our methods with respect to sternal metastases (n = 48 papers) ( Table 5 ).…”

“… Overview of published case reports (N = 34) according to our methods [ 14 , 15 , 16 , 17 , 19 , 23 , 25 , 26 , 30 , 32 , 33 , 37 , 38 , 41 , 42 , 43 , 47 , 52 , 55 , 56 , 59 , 60 , 62 , 68 , 71 , 76 , 77 , 78 , 89 , 98 , 99 , 100 , 101 , 102 ]. Abbreviations: N = number of patients; MiNEN = mixed neuroendocrine–non-neuroendocrine tumour.…”

“…Table 5. Single case reports of sternal metastases according to our methods; the articles are cited starting with the most recent time of publication [14][15][16][17]19,23,25,26,30,32,33,37,38,[41][42][43]47,52,55,56,59,60,62,68,71,[76][77][78]89,[98][99][100][101][102]. The case we mentioned brought up the importance of addressing a sternal biopsy into the larger frame of multi-lined, complex management.…”