Breathing adapted radiation therapy for leukemia relapse in the breast: A case report

Abstract

BACKGROUNDInfiltration of the breast by leukemic cells is uncommon but may manifest as an oncological emergency requiring prompt management. Extramedullary relapse of T-cell acute lymphoblastic leukemia (T-ALL) within the breast is exceedingly rare and there is paucity of data in the literature regarding this entity. No consensus exists on management of isolated extramedullary breast relapses of T-ALL. Herein, we report a case of isolated extramedullary breast relapse of T-ALL treated with breathing adapted radiation therapy (BART) using the active breathing control (ABC) system.CASE SUMMARYThe patient was a 33-year-old female with diagnosis of T-ALL. She received intensive systemic chemotherapy that resulted in complete remission of her disease, and then underwent allogeneic hematopoietic stem cell transplantation. After a 15 mo period without symptoms and signs of progression, the patient presented with palpable masses in both breasts. She complained from severe pain and swelling of the breasts. Imaging workup showed bilateral breast lesions, and diagnosis of breast infiltration by leukemic cells was confirmed after immunohistopathological evaluation. The patient suffering from severe pain, discomfort, and swelling of both breasts due to leukemic infiltration was referred to the Radiation Oncology Department for symptomatic palliation. Whole breast irradiation was delivered to both breasts of the patient with BART using the ABC system. The patient had complete resolution of her symptoms after treatment with BART.CONCLUSIONBART with the ABC system resulted in complete resolution of the patient’s symptoms due to leukemic infiltration of both breasts with T-ALL. This contemporary treatment technique should be preferred for radiotherapeutic management of patients with leukemic infiltration of the breasts to achieve effective symptomatic palliation.

Determination of Radiosurgery Treatment Volume for Intracranial Germ Cell Tumors (GCTS)

“…Axial MRI of intracranial GCT is demonstrated on Figure 2. [32][33][34][35][36][37][38][39]. In the context of intracranial GCT management, irradiation with less extensive treatment portals and lower doses has been investigated for improved normal tissue sparing and quality of life.…”

Assessment of the role of multimodality imaging for treatment volume definition of intracranial ependymal tumors: An original article

“…In this regard, accurate treatment volume determination is an indispensable aspect of contemporary irradiation strategies. There has been signifi cant progress with excellent improvements regarding radiation oncology practice by introduction of modernized treatment equipment, contemporary and adaptive irradiation strategies [16][17][18][19][20]. With regard to radiotherapeutic management of intracranial ependymomas, accumulating data suggest promising treatment results [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Evaluation of Radiosurgery Target Volume Definition for Tectal Gliomas with Incorporation of Magnetic Resonance Imaging (MRI): An Original Article

“…RT may be used as part of management for tectal gliomas. There have been significant improvements in the discipline of radiation oncology recently such as Image Guided Radiation Therapy (IGRT), Adaptive Radiation Therapy (ART), Intensity Modulated Radiation Therapy (IMRT), Breathing Adapted Radiation Therapy (BART), and stereotactic irradiation with SRS, HFSRT, and SBRT [41][42][43][44][45][46][47]. Radiosurgery has been used for treatment of tectal gliomas with encouraging outcomes [16,17].…”