Palliative dose for bleeding mass in the breasT

[Kroll2013]

What dose schedule would you recommend for a bleeding mass in the breast, in the setting of metastatic BC?
( 1*8 Gy, 10*3Gy, .....?)

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[Gfunk6]

Depends a lot on the KPS/prognosis of patient. Probably the fastest I would go is a quad shot (3.7 Gy bid for two consecutive days). May also consider 30 Gy in 10 fractions. If pt is good KPS then 45 Gy in 15 fractions is another reasonable option IMO.

 

[Burt Radnolds]

Its really dependent on performance status, as mentioned above. Metastatic breast cancer patients can have very extended survivals. If I'm going for long term control, I like 45/15 as well. If it makes you nervous, its very similar adjuvant whole breast hypofractionation (42.56 in 16).

 

[Reaganite]

I've treated way more of these than I ever expected, and I agree-be aggressive with your palliation. These patients often live a while and local control is paramount. 45 in 15 is reasonable. I've gone even higher on a pt with limited metastatic disease largely based on my very first case years ago which in retrospect I under-palliated. Uncontrolled inflammatory breast ca is catastrophic and a very horrible way to die. My other rec is to be very generous with your fields.

 

[medgator]

Wow, I rarely see this, maybe they are just getting toilet mastectomies or something in my area....

 

[BobbyHeenan]

I treated a couple in residency - haven't seen this yet out in practice. The one I remember best we did 5 Gy every other day to 25 Gy total for a debilitated elderly patient with transportation issues. I believe we did a field-in-field type of thing where the tumor got 5 Gy and the rest of the breast got 4 Gy per fraction. The mass melted away, it was amazing. Tolerated very well. She lived about 9 more months, but was pain free in the breast.

 

[Treat]

I treated a couple in residency - haven't seen this yet out in practice. The one I remember best we did 5 Gy every other day to 25 Gy total for a debilitated elderly patient with transportation issues. I believe we did a field-in-field type of thing where the tumor got 5 Gy and the rest of the breast got 4 Gy per fraction. The mass melted away, it was amazing. Tolerated very well. She lived about 9 more months, but was pain free in the breast.

In my center, we do 25 Gy in 5 daily fractions quite routinely when a short course is desired. It's quite tolerable.

 

[Pewl]

45/15 is good. Haven't tried the 25/5 regimen. I may look into that if a short treatment course is needed.