Hormone-positive breast cancer with axillary recurrence responding to hyperthermia, radiation, and chemotherapy

What happened, in summary

This 66-year-old woman previously underwent mastectomy and axillary lymph node dissection for breast cancer. Pathology showed papillo-tubular carcinoma with metastases in 2 axillary lymph nodes. Immunohistochemistry showed estrogen receptor-positive and progesterone receptor-positive disease, with HER2 negative. After surgery, she received adjuvant doxorubicin at 60 mg/m² plus cyclophosphamide at 600 mg/m² for 4 cycles, followed by an aromatase inhibitor for 5 years. She did not receive post-mastectomy radiotherapy at that time. Nine years after surgery, a local recurrence appeared in the left axillary area, measuring about 5 cm. Weekly paclitaxel at 80 mg/m² and radiotherapy to 30 Gy were attempted, but the lesion continued to enlarge. Because the tumor was not responding, the team added hyperthermia to the ongoing radiotherapy and chemotherapy approach. Hyperthermia was delivered with a capacitive heating device once weekly for 50 minutes, with a surface temperature of 38°C to 41°C and output power between 1,300 and 1,400 W. After 4 weeks, the tumor surface began to break down and became necrotic; as the tumor shrank, the foul odor disappeared. By 8 weeks, the tumor had become nearly flat. The response was assessed as a complete response by RECIST criteria, and the patient reported improved ability to carry out daily activities. The documented course shows a hormone receptor-positive, HER2-negative breast cancer with late axillary recurrence that responded after hyperthermia was added to treatment. The response was clinically meaningful because the enlarging axillary tumor had caused odor and impaired daily comfort before hyperthermia was added, and both tumor appearance and daily activity improved afterward.