A Multidisciplinary Approach to the Treatment of Inoperable Locally Advanced Breast Cancer with a Fungating Wound: A Case Report and Literature Review

Abstract

Introduction. Locally advanced breast cancer accounts for 5-10 % of all cases of breast cancer in economically developed countries. A particularly rare group of such patients comprises women with significant local tumor growth leading to infiltration of the breast skin, neoplastic ulcerations, tumor lysis and secondary infection. This type of tumor is often accompanied by edema, necrosis, fetid odor, profuse exudate, pain, bleeding and symptoms of infection. Treatment of such cases is difficult, complex, and requires a multidisciplinary approach.

Case description. The article presents a clinical case of a patient with a long-term untreated triple-negative breast cancer, which led to an inoperable locally advanced cancer with large tumor mass, neoplastic fungating wounds, bleeding, and systemic inflammatory response syndrome. Against the background of antibacterial therapy, prevention of tumor lysis syndrome, primary prophylaxis of febrile neutropenia, the patient was started neoadjuvant chemotherapy for vital indications. After completion of the treatment with weekly paclitaxel + carboplatin regimen (12 cycles) and dose-dense AC regimen (4 cycles), a good clinical response was achieved, the complications were fully relieved, and the patient underwent radical surgery. The histological report showed a complete pathomorphological response. Currently, the patient is in remission. This case illustrates the success in a multidisciplinary treatment of a statistically difficult to manage condition with poor prognosis. The literature review shows the main treatment approaches for this group of patients.