long-term breast tumor control with brachytherapy and external beam radiotherapy: a case report

While surgical resection of the primary tumour and regional nodes is part of the standard algorithm for the treatment of early-stage invasive breast carcinomas, not all patients are surgical candidates or agree for surgery. this case report is about one such patient who refused surgery for a biopsy confirmed in the 7th edition of the tumour, nodes, metastases (tnm) classification system (tnm7) t2n1m0 left breast infiltrative ductal carcinoma with estrogen receptor/ progesterone receptor positive and human epidermal growth factor receptor 2 negative for personal reasons.a 39-year-old lady presented with left breast mass at upper outer quadrant, which confirmed to be infiltrative ductal carcinoma with luminal a sub-type from the biopsy report. despite the early stage of breast cancer, she refused for surgery because of personal reasons. therefore, she underwent 12 cycles of chemotherapy followed by radiotherapy to the left breast and regional nodes to a dose of 50 gy in 25 fractions (fx) and further high dose rate (hdr) brachytherapy boost of 16 gy in 1 fx to the 2.0 × 2.0 cm residual lesion. after the completion of the treatment, the patient was on 20 mg tablet tamoxifen daily.during follow-up, there was a residual fibrotic lesion in the left breast from the computed tomography scan, and there was a doubt on the nature of the lesion. thus, the patient was subjected to excision of the lesion and regional nodes, which showed a pathological complete response of three years after the completion of hdr brachytherapy. while surgery is the standard of care, this case report shows that definitive hdr brachytherapy has a role in patients not suitable for surgery.