Systemic Therapy with Radiation to the Chest Wall Alone

This case highlights the therapeutic dilemma encountered in patients with limited metastatic disease, who have both a substantial risk of local–regional recurrence (LRR) and a large competing risk of distant metastases (1). If the patient had presented without metastatic disease, her initial tumor burden would have warranted radiation. However, in the setting of metastatic disease, treatment recommendations are less clear. The available retrospective literature in women with inflammatory disease suggests that aggressive local treatment improves local control (2) and may even benefit overall survival (3), but these data are limited in their generalizability owing to biases in patient selection.

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