Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2019; 10(11): 369-374
Published online Nov 24, 2019. doi: 10.5306/wjco.v10.i11.369
Breathing adapted radiation therapy for leukemia relapse in the breast: A case report
Omer Sager, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz, Fatih Ozcan, Onurhan Colak, Yelda Elcim, Bahar Dirican, Murat Beyzadeoglu
Omer Sager, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz, Fatih Ozcan, Onurhan Colak, Yelda Elcim, Bahar Dirican, Murat Beyzadeoglu, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
Author contributions: Sager O contributed to data acquisition and interpretation, reviewed the literature, and was responsible for manuscript drafting and submission; Dincoglan F performed treatment planning and took part in manuscript drafting; Demiral S participated in manuscript designing and drafting; Uysal B contributed to data acquisition and interpretation; Gamsiz H reviewed the literature and was responsible for checking the manuscript for important intellectual content; Ozcan F participated in data acquisition and interpretation; Colak O contributed to manuscript designing and drafting; Elcim Y took part in data acquisition and treatment planning; Dirican B played a role in treatment planning and manuscript drafting; Beyzadeoglu M participated in designing, reviewing and drafting the manuscript; All authors read and approved the final manuscript.
Informed consent statement: We obtained informed consent for publication.
Conflict-of-interest statement: The authors state that they have no conflicts of interest.
CARE Checklist (2016) statement: The manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Omer Sager, MD, Associate Professor, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Gn.TevfikSaglam Cad, Ankara 06018, Turkey. omer.sager@sbu.edu.tr
Telephone: +90-312-3044682 Fax: +90-312-3044680
Received: May 17, 2019
Peer-review started: May 20, 2019
First decision: August 2, 2019
Revised: September 4, 2019
Accepted: September 25, 2019
Article in press: September 25, 2019
Published online: November 24, 2019
Processing time: 192 Days and 17.1 Hours
Abstract
BACKGROUND

Infiltration 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 SUMMARY

The 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.

CONCLUSION

BART 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.

Keywords: T-cell acute lymphoblastic leukemia; Breast relapse; Breathing adapted radiation therapy; Active breathing control; Case report

Core tip: Although exceedingly rare, leukemic infiltration of the breasts by T-cell acute lymphoblastic leukemia (T-ALL) may manifest as an oncological emergency requiring prompt management. In this case report, we present the first case in the literature treated by breathing adapted radiation therapy using the active breathing control system for management of isolated extramedullary relapse of T-ALL in both breasts.