ArticleFrontiers in oncology2026
Case Report: Image-guided adaptive lattice radiotherapy for a 2,772-cc ulcerative triple-negative breast cancer.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Giant ulcerative breast cancers (>2,000 cc) with active hemorrhage present a critical therapeutic challenge, as conventional radiotherapy carries a high risk of severe toxicity to surrounding organs. Lattice radiotherapy (LRT) delivers spatially fractionated high-dose vertices within a low-dose background, offering the potential to overcome dose constraints. However, rapid tumor regression induced by LRT may render fixed plans unsafe, necessitating adaptive replanning. Case presentation: A 46-year-old female with stage IV triple-negative breast cancer (TNBC; BRCA1 germline mutation) presented with a 2,772.2-cc ulcerative left breast and axillary masses complicated by persistent hemorrhage, recurrent infection, and Eastern Cooperative Oncology Group (ECOG 3). After failure of systemic therapies including fluzoparib, image-guided adaptive LRT was initiated (gross tumor volume [GTV]: 12 Gy/4 fractions; lattice vertices: 60 Gy/4 fractions). Before fractions 2-4, the GTV was re-contoured on daily fan-beam computed tomography (FBCT), lattice vertices were redistributed away from the skin surface, and plans were recalculated. LRT was followed by conventionally fractionated VMAT (40 Gy/20 fractions). Hemorrhage ceased within 2 weeks and persistent fever subsided, becoming intermittent and progressively less frequent. Tumor volume progressively decreased by 21.2% during LRT (before fraction 4), 81.5% post-VMAT, and 96.1% (108.3 cc residual) at 2-month follow-up. Cumulative organ-at-risk (OAR) doses, estimated by rigid-registration dose accumulation, remained within tolerance, with only Grade 2 dermatitis and no ≥Grade 3 toxicity. Conclusion: This case demonstrates the technical feasibility of image-guided adaptive lattice replanning in a rapidly changing, ultra-large fungating breast tumor. Adaptive replanning may reduce geometric displacement of high-dose vertices; however, its dosimetric and clinical benefits require confirmation in further patients and with longer follow-up.
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