Systemic therapy of inflammatory breast cancer with type 2 diabetes mellitus – Prevention of high risk of radiation-induced progression of tumor tissue cancer

Abstract

Introduction. Cancer mortality in diabetic patients has been reported to increase moderately compared to non-diabetic patients. The aim of the study aimed to assess the findings and identify radiotherapy's role in the comprehensive care of diabetic IBC patients with various hyperglycemia correction strategies. Methods. Patients with diabetes have shown a higher risk of radiation-induced cancer progression for tumor tissue, especially for inflammatory form. For 7 patients, to continue systematic chemotherapy with a scheme change (consecutive anthracyclines-taxanes, 2-week interval) and insulin with individual scheme for hyperglycemia correction on the basis of glycemic control – 1st group, the other (7 patients) – 2nd group, was given radiotherapy to the breast gland and lymphatic drainage ways. 45–50 Grey was prescribed for 25-28 fractions (per 1.8-2.0 Grey), 46–50 Grey in 23-25 fractions were used for zones of regional metastasis and for hyperglycemia correction metformin 2000 mg/day PO divided q8-12hr with meal on the basis of glycemic control. Results. Assessed were the number of patients who qualified for surgery and overall survival for 24 months. 2nd group showed a superior response following resistance to prior systemic treatment. Thus, 5 (71.41%) of the 7 patients exhibited a consistent response – complete or partial regression. There were only 2 individuals (28.61%) who responded to treatment among the patients who maintained chemotherapy. Conclusions. Breast cancer of the aggressive IBC variety requires multidisciplinary treatment from breast surgery, medical, and radiation oncology. Patients with diabetes appear to experience more side effects from radiation therapy than patients without the disease. Hyperglycemia, higher total RT doses, and radiosensitizers are a few techniques that can improve the impact of RT on local-regional management. Local-regional control rates for IBC are increasing with an individual patient strategy. Metformin also improves insulin resistance and has anticancer benefits.