Stage IV Breast Cancer With Long-Term Tumor Regression After Radiation Therapy

What happened, in summary

A 65-year-old woman sought radiation-oncology care after living with a breast mass for about 3 years. The mass had become ulcerated and necrotic, with bleeding, foul-smelling discharge and severe pain. Imaging showed a large fungating breast and axillary mass of about 16 cm, and a bone scan identified metastasis in the 8th thoracic vertebra. Biopsy and staging identified Stage IV invasive ductal carcinoma that was estrogen-receptor positive, progesterone-receptor negative and HER2-positive. She had declined conventional surgery, chemotherapy and hormone therapy. Instead, she received an intensive electron-beam radiation course directed at the breast tumor and involved axillary nodes: 225 Gy in 15 fractions over 3 weeks. She then received 50 Gy in 25 fractions to the metastatic thoracic vertebral lesion. Follow-up imaging showed marked shrinkage and near-complete regression of the breast tumor and a substantial reduction in the axillary nodes. After 2 years, the bone scan showed resolution of the vertebral metastatic lesion. A 2015 biopsy of the irradiated breast site showed fibrosis without tumor cells. Later routine imaging found no abnormality, tumor markers returned to normal, and follow-up showed no further recurrence. She returned to work, felt very well and had a good quality of life.