Radiotherapy in the treatment of malignant fungating wounds: clinical practice, response rates, and outcome from a tertiary cancer center.

Purpose: Malignant fungating wounds (MFW) are a distressing condition caused by aggressive tumor growth infiltrating the skin. Regularly causing pain, exudation, bleeding, edema and odor, they negatively affect the patients' quality of life (QoL). Radiotherapy (RT) can reduce MFW-associated symptoms and is routinely used in clinical settings, both in curative as well as palliative treatment regimes. However, fundamental data on treatment response, symptom relief and oncological outcomes, as well as potential confounders of treatment response are currently limited.

Methods: We performed a retrospective analysis of patients with MFW who received RT between 01/2000 and 06/2022 at our tertiary cancer center. Achievement of treatment goals, including reduction of pain and tumor mass, cessation of bleeding, and improvement of wound condition, were evaluated. The effect of variables on the achievement of treatment goals were assessed by logistic regression. The effect of parameters on overall survival (OS) were assessed using the Kaplan-Meier plot with log-rank test and Cox regression analysis. Statistically significant (p-value < 0.05) confounders were tested in multivariable analyses.

Results: 101 patients were included. 69.3% of treatments were in palliative intent, 30.7% in curative intent. Main tumor entities were breast cancer, squamous cell carcinoma of the skin and vulvar carcinoma, accounting for 26.7, 22.8 and 9.9% of patients. Main treated locations were head & neck (38.6%), breast/chest wall (29.7%) and genitals (9.9%). Main treated areas were primary tumor (52.5%) and metastasis (22.8%). Concurrent systemic therapy was administered in 32.7%. The predefined therapy goal was achieved in 85% of patients. Median overall survival was 7.8 months. Concurrent systemic therapy was statistically significant associated with achieving the therapy goal [logistic regression; HR 8.45 (95% CI: 1.06-67.37, p = 0.04)]. Concurrent systemic therapy, lower CCI and achieving the therapy related goal were significantly associated with higher overall survival. Overall toxicity was low.

Conclusion: RT for MFW is a highly effective treatment option, resulting in very high local tumor regression rates. It therefore reduces the numerous negative QoL-affecting consequences for the patients, which often present in a palliative state. Concurrent systemic therapy can be a prognostically relevant treatment option.