Recurrent Metastatic Breast Carcinoma

Medical Summary

Mrs. ARC was first seen at the Tata Memorial Hospital on 18.5.10 with complaints of lump in the left breast. She was investigated and diagnosed as a case of carcinoma left breast and underwent left modified radical mastectomy on 26.5.10. The histopathological review of the specimen revealed a 2 x 1.5 cm tumour (IDC grade II).

Treatment

All 16 axillary nodes dissected were negative for metastasis. Post-operatively she was started on adjuvant chemotherapy Tamoxifen 10 mg bd which was stopped in 2013. In july 2015 she presented with hoarseness of voice. A CT scan of thorax and abdomen done on 3.11.15 showed a soft tissue mass in antero-superior mediastinum encasing the left subclavian and the left common carotid artery with caudal extension upto the level of aortic arch.

She was posted for palliative radiation therapy and was found to be in good general condition with Karnofsky performance score of 90%. There was no evidence of peripheral lymphadenopathy or organomegaly. Locally there was no evidence of disease over the left chest wall. Haematological examination did not reveal any abnormality. Bone scan done on 8.1.15 showed multiple areas of increased tracer uptake. X-ray cervical and lumbosacral spine done on 25.11.15 was suggestive of cervical spondylosis.

She received 2 cycles of Inj. Taxotere + Carboplatin on 12.11.15 and 4.12.15.

She received palliative radiation therapy to the mediastinum with 6MV photons with AP/PA portals to a dose of 30 Gy/15fr/32 days followed by localised boost with right & left anterior oblique ports to a dose of 26 Gy/14fr/28 days thus delivering a total cumulative dose of 56 gGy/29 fr/53 days from 8.12.15 to 30.1.16. Radiotherapy was tolerated well with moderate symptomatic improvements, with a bout of chemotherapy induced neutropenia which was managed using colony stimulating factor (Neupogen).

Third course of chemotherapy (Taxotere + Carboplatin) was given on 10.2.16 & the 4th course was given on 5.3.16.

She has been advised two more courses at intervals of three weeks.

Following completion of the above, she will be re-evaluated.

I would really like a second-opinion, suggestions, advise & will be grateful for the same.

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