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ORIGINAL CONTRIBUTION
Year : 1999  |  Volume : 53  |  Issue : 6  |  Page : 267-269
 

Management of advanced breast cancer : A case report*


SS Veterans Hospital, Subroto Park, New Delhi 110 010., India

Correspondence Address:
A K Gupta
SS Veterans Hospital, Subroto Park, New Delhi 110 010.
India
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PMID: 10776508

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How to cite this article:
Gupta A K, Ticku J L. Management of advanced breast cancer : A case report*. Indian J Med Sci 1999;53:267-9

How to cite this URL:
Gupta A K, Ticku J L. Management of advanced breast cancer : A case report*. Indian J Med Sci [serial online] 1999 [cited 2014 Dec 20];53:267-9. Available from: http://www.indianjmedsci.org/text.asp?1999/53/6/267/12223


Breast cancer is common and its incidence is increasing. Survi­val curve steeply falls after stage 11 disease because the disease is considered to become systemic. Advanced (metastatic) cancer is a terminal disease : inevitably the patient relapse on whatever treat­ment is administered. Overall sur­vival does not increase, but the aim of treatment is to improve the quality of life. Nevertheless with advance treatment number of ef­fected women may survive for many years i.e. median survival of women presenting with stage IV breast cancer was 41 months re­ported by Paterson [1] Current the­rapy therefore focuses on pallia­tion, trying to prolong the remain­ing life span while minimising any discomfort from either treatment or disease.

Case Report: Perimenopausal 46 years old female case of cancer right breast grade III with depo­sits in lymphnodes (12/14) in­cluding right apical lymphnode (T310M0 ) diagnosed in March 94. She was treated with simple mas­tectomy with axillary clearance (Oncosurgery) followed by 4 pul­ses of Chemotherapy (Cyclophos­phamide, Methotrexate and 5 FU) and radiation (external radiation to chest wall and drainage area) completed by Nov 94. Histopatho­logicaly it was infiltrative duct car­cinoma and breast tissue was stained immunocyto-chemically with monoclonal antibodies for estrogen and progestron receptors. Semiquentatinely ER and PR pos­tinity was one plus (reactivity was scaled from 0 to 3 plus). She was advised tamoxifen 20 mgm daily as a prophylatic drug for recurrence. Since then she was in remmission. In Nov 97 she reported with pain chest and was found to have mali­gent Rt sided pleural effusion. On further evaluation secondary depo­sits detected in liver (USG follow­ed by CT abdomen) and bonny metastatic deposit in D 12 (Isotope bone scan). She was treated with salvage chemotherapy (Texol and Cisplatin) and intrapleural instal­lation of bleomycin. Among ad­juvant endocrine therapy tamoxi­fen was stopped and denazol 200 mgm per day was given as a prophylatic measure for further dis­tant metastasis. By Feb 98, she became asymptomatic, pleural ef­fusion disappeared and ultrasono­graphically metastatic deposits in liver had also disappeared. After 4th pulse of chemptherapy in end of Feb. she had bonemarrow dep­ression (neutropenia, TLC 1430 per microlitre with 21% neutro­phils i.e. absolute neutrophil count 301) managed with leuco­mex (rHu GM-CSF). Her serum marker Ca- 15-3 was with in normal Emits, so further no antimitotic drug was given and was only con­sidered for hormone therapy. Since then she was in remission end was taking only danazol orally.

On routine follow up, in June 98, a subcutanous painless hard no­nodule was detected in right side of chest. On biopsy followed by H/P examination it was found to besecondary metastatic deposits and on futher evaluation liver again showed solitary hypoechoic (1.0 cm x 0.9 cm) shadow ultra-sonographically probably again secondary deposits. Denazol stop­ped and she was again considered for chemotherapy (Oncotran, vin­cristin and carboplatin) with aromatose inhibitor as adjuvant endocrine therapy. 2 pulses dur­ing the past two months were ad­vocated and patient is tolerating well. Latest USG abdomen reveal­ed same size of solitary hypo­echoic shadow in liver. Presently patient as asymptomatic and lead­ing her normal life.


 ¤ Discussion Top


Management of breast cancer is major health care priority. Apart from Oncosurgery and radiothe­rapy there is a role of systemic therapy in the form of chemo and endocrine therapy, specially in the treatment of distant metastasis. Adjuvant therapies are mainly sys­temic, likely to achieve long term control of disease throughout the body. Similarly combination of drugs induces higher response rate and improved survival com­pared with serial treatment. Re­lapse of failure of response to a specific endocrine treatment usually occur within two years. [2],[3] Response to first Line treatment last only for 9-12 months in oestro­gen receptor positive metastatic breast cancer (or 2-3 years in micrometastatisis). However re­peated response can be achieved by using a sequence of endocrine agents with different modes of action, although the duration of res­ponse and the type and extent of remmission in most of the cases gradually decline. [4] For the manage­ment of recurrence of distant meta­stasis change in cytotoxic drug and endocrine therapy is required to avoid drug resistance and their toxic effects. In such cases aim of the treatment is to prolong the life span by palliaive measures which should be effective and well tolerated. In this case, when the presented in relapse with secon­dary metastasis after 3 years, she was managed with different regi­men of chemo and endocrine therapy. After 4th pulse her hepa­tic deposits and pleural effusion disappeared (ultrasonographically) and she went into remmission. After 3 months, again whe she presented with secondary deposits (hepatic and bonny), she was managed with different cytotoxic drugs and changed endocrine therapy, Again she tolerated and responded very well. Thus our aim in such patients should be to pro­vide maximum comfort and im­prove the life span quantitatively and qualitatively only by palliative measures which should be effec­tive and well tolerated.

 
 ¤ References Top

1.Paterson AH. The natural history breast cancer and the impact of systemic therapy. In : Powles TJ, Smith IE (ed) : Medical management of breast cancer. Dunitz, London, 1991.  Back to cited text no. 1    
2.Commbes RC. Clinical studies with 4-hydroxyandros-tenedione in ad­vanced cancer. In : Commbes RC, Dowsett M (eds) 4-hydroxyand­rostenedione - a new approach to hormone depenent cancer. Int Cong and Sympos Series, Royal Soc Med Services Ltd. London, 1991.  Back to cited text no. 2    
3.Stein RC, Dowsett M, Hedley A. Treatment of advanced breast can­cer in postmenopausal women with 4 hydroxyandrostenedione. Cancer Chemother Pharmacol, 1990;26: 75-73.  Back to cited text no. 3    
4.Smith JE, Harris AL, Morgan M. Tamoxifen versus aminoglutethi­mide in advanced breast carcinoma: a randomised cross-over trial. Br Med J 198Y;283:1432-1434.  Back to cited text no. 4    




 

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