Ulcerative giant breast cancers (UGBC) cause life-threatening bleeding, infections and severe pain, and are hard to treat in chemotherapy-intolerant patients with poor responses to standard therapies.The emergence of groundbreaking modified lattice radiotherapy offers an effective salvage option for refractory ulcerated giant breast cancer, providing an alternative therapeutic approach for these patients.

Recently, the radiotherapy team at Jiahui International Cancer Center of Jiahui International Hospital published a landmark case study in the internationally renowned journal Breast Cancer: Basic and Clinical Research. A 51-year-old woman with a 20.5 cm × 6.98 cm × 18.17 cm stage IIIC hormone receptor-positive, HER2-negative bleeding ulcerated UGBC refused chemotherapy due to severe anemia and side effect concerns. Given this complex condition, the Jiahui oncology team used a combined regimen: modified lattice radiotherapy followed by subsequent volumetric-modulated arc therapy and oral systematic therapy. 

Bleeding stopped quickly within 5 days, tumor size dropped by 39.7% at week 4, and the sore healed steadily. At the 3-month post-mLRT, the tumor shrank by 61.8%, the ulcer almost fully grew new skin, and no cancer spread was found. After full treatment, the tumor shrank 92.9% compared with initial size, reaching full clinical remission. The skin lesion healed completely without relapse or distant spread, and the patient’s quality of life improved significantly. 

The modified lattice radiotherapy (mLRT) used in this protocol delivers high‑dose radiation to targeted areas and low‑dose radiation to the remaining tumor, effectively controlling the tumor while protecting vulnerable organs. This innovative treatment achieved four major technical breakthroughs:

• Precisely targets the key region of tumor, delivering high‑dose radiation to bleeding areas and the tumor center;
• Protects surrounding normal tissues with low‑dose exposure, avoiding injury to the heart, lungs, brachial plexus (major arm nerves), and chest wall;
• Uses CT‑guided adaptive planning before each treatment to dynamically match tumor regression and bleeding changes;
• Combines with endocrine and targeted therapy to achieve synergistic effects of local tumor control plus systemic stabilization.
  

This clinical practice demonstrates that the technique provides a rapid, non‑invasive salvage strategy for ulcerated giant breast cancer and creates favorable conditions for subsequent treatment, offering a solution from China and practical experience for palliative and salvage care of advanced breast cancer worldwide. This breakthrough further confirms Jiahui International Cancer Center’s commitment to delivering personalized treatment for patients with complex and refractory cancers through innovative radiotherapy and multidisciplinary collaboration, safeguarding lives with technology.

Figure 1.

Tumor size with CT images presentation of UGBC at different times. (A) December 7, 2023. A CT scan of the right breast revealed a large ulcerative invasive ductal carcinoma with a 3-dimensional size of 15.26 × 15.41 × 7.38 cm, with central ulceration and ipsilateral axillary lymph node metastasis. (B) October 28, 2024. A follow-up CT scan demonstrated significant tumor progression to 20.5 × 6.98 × 18.17 cm with obvious effusion, active bleeding, aggravated central ulceration, and the tumor invaded the surrounding chest wall soft tissues. Imaging parameters: 16-slice CT scanner (soft tissue window, width: 600 HU, window level: 640 HU, 3 mm slice thickness, 120 kV, and 200 mAs).

Figure 2.

Coronal CT images of the UGBC during treatment and follow-up in chronological order. October 29, 2024: Pre-mLRT, active tumor bleeding with massive ulcerative lesion. November 8, 2024: A week post 3 fractions of mLRT (mLRT completion), complete hemostasis, and initial tumor regression (24.7% volume reduction vs pre-treatment baseline). December 3, 2024: 4 weeks post-mLRT completion, modest tumor regression (39.7% volume reduction vs pre-treatment baseline). February 6, 2025: 14 weeks post overall radiotherapy initiation, significant tumor regression (61.8% volume reduction vs pre-treatment baseline). March 18, 2025: Near-complete epithelialization of the ulcerative lesion, minimal residual tumor tissue at the primary site. March 31, 2025: 5 months post-mLRT, minimal residual disease (MRD) (92.9% volume reduction vs pre-treatment baseline). April 8, 2025: Tumor nearly completely regressed at the primary lesion. April 15, 2025: Clinically stable condition, no evidence of local recurrence or distant metastasis.