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Case report
peer-reviewed

Severe Late Toxicity After Adjuvant Breast Radiotherapy in a Patient with a Germline Ataxia Telangiectasia Mutated Gene: Future Treatment Decisions



Abstract

Ataxia telangiectasia mutated (ATM) gene mutations may confer increased sensitivity to ionizing radiation and increased risk of late toxicity for cancer patients. We present the case of a 55-year-old female treated with adjuvant breast and regional nodal radiation following lumpectomy and axillary lymph node dissection for stage II invasive ductal carcinoma of the breast. She developed severe telangiectasia, fibrosis, induration, chest wall pain (with evidence of rib fractures on imaging), and painful limitation in her range of motion at the shoulder. She was subsequently found to have a likely pathogenic germline ATM gene mutation. At relapse, she elected to pursue systemic therapy alone for intracranial metastases.



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Case report
peer-reviewed

Severe Late Toxicity After Adjuvant Breast Radiotherapy in a Patient with a Germline Ataxia Telangiectasia Mutated Gene: Future Treatment Decisions


Author Information

Maryam Dosani Corresponding Author

Radiation Oncology, BC Cancer Agency, Vancouver Centre

Kasmintan A. Schrader

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Alan Nichol

Radiation Oncology, BC Cancer Agency, Vancouver Centre

Sophie Sun

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Medical Oncology, BC Cancer Agency, Vancouver Centre

Tamara Shenkier

Medical Oncology, BC Cancer Agency, Vancouver Centre

Zoe Lohn

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Gudrun Aubertin

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Scott Tyldesley

Radiation Oncology, BC Cancer Agency, Vancouver Centre


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. BC Cancer Agency Research Ethics Board issued approval. The case report was reviewed with British Columbia (BC) Cancer Agency Research Ethics Board, which confirmed their policy of not requiring ethics review for case reports. Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Severe Late Toxicity After Adjuvant Breast Radiotherapy in a Patient with a Germline Ataxia Telangiectasia Mutated Gene: Future Treatment Decisions


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Case report
peer-reviewed

Severe Late Toxicity After Adjuvant Breast Radiotherapy in a Patient with a Germline Ataxia Telangiectasia Mutated Gene: Future Treatment Decisions

  • Author Information
    Maryam Dosani Corresponding Author

    Radiation Oncology, BC Cancer Agency, Vancouver Centre

    Kasmintan A. Schrader

    Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

    Alan Nichol

    Radiation Oncology, BC Cancer Agency, Vancouver Centre

    Sophie Sun

    Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

    Medical Oncology, BC Cancer Agency, Vancouver Centre

    Tamara Shenkier

    Medical Oncology, BC Cancer Agency, Vancouver Centre

    Zoe Lohn

    Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

    Gudrun Aubertin

    Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

    Scott Tyldesley

    Radiation Oncology, BC Cancer Agency, Vancouver Centre


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. BC Cancer Agency Research Ethics Board issued approval. The case report was reviewed with British Columbia (BC) Cancer Agency Research Ethics Board, which confirmed their policy of not requiring ethics review for case reports. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: July 11, 2017

    DOI

    10.7759/cureus.1458

    Cite this article as:

    Dosani M, Schrader K A, Nichol A, et al. (July 11, 2017) Severe Late Toxicity After Adjuvant Breast Radiotherapy in a Patient with a Germline Ataxia Telangiectasia Mutated Gene: Future Treatment Decisions. Cureus 9(7): e1458. doi:10.7759/cureus.1458

    Publication history

    Received by Cureus: May 23, 2017
    Peer review began: June 06, 2017
    Peer review concluded: July 08, 2017
    Published: July 11, 2017

    Copyright

    © Copyright 2017
    Dosani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Ataxia telangiectasia mutated (ATM) gene mutations may confer increased sensitivity to ionizing radiation and increased risk of late toxicity for cancer patients. We present the case of a 55-year-old female treated with adjuvant breast and regional nodal radiation following lumpectomy and axillary lymph node dissection for stage II invasive ductal carcinoma of the breast. She developed severe telangiectasia, fibrosis, induration, chest wall pain (with evidence of rib fractures on imaging), and painful limitation in her range of motion at the shoulder. She was subsequently found to have a likely pathogenic germline ATM gene mutation. At relapse, she elected to pursue systemic therapy alone for intracranial metastases.



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Create a free account to continue reading this article.

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Maryam Dosani

Radiation Oncology, BC Cancer Agency, Vancouver Centre

For correspondence:
maryam.dosani@bccancer.bc.ca

Kasmintan A. Schrader

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Alan Nichol

Radiation Oncology, BC Cancer Agency, Vancouver Centre

Sophie Sun

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Tamara Shenkier

Medical Oncology, BC Cancer Agency, Vancouver Centre

Zoe Lohn

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Gudrun Aubertin

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Scott Tyldesley, M.D., Professor

Radiation Oncology, BC Cancer Agency, Vancouver Centre

Maryam Dosani

Radiation Oncology, BC Cancer Agency, Vancouver Centre

For correspondence:
maryam.dosani@bccancer.bc.ca

Kasmintan A. Schrader

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Alan Nichol

Radiation Oncology, BC Cancer Agency, Vancouver Centre

Sophie Sun

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Tamara Shenkier

Medical Oncology, BC Cancer Agency, Vancouver Centre

Zoe Lohn

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Gudrun Aubertin

Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre

Scott Tyldesley, M.D., Professor

Radiation Oncology, BC Cancer Agency, Vancouver Centre