Case Summary: Synchronous Primary Malignancy – Breast and Cervical Carcinoma

A 39-year-old female was diagnosed with carcinoma of the left breast (Invasive Ductal Carcinoma Grade 3, ER/PR positive, HER2/neu negative) and underwent breast-conserving surgery (lumpectomy) at a government hospital in 2023. Axillary lymph node dissection was not performed. The patient was subsequently lost to follow-up, resulting in incomplete adjuvant treatment.

In November 2024, she presented to our institution with complaints of abnormal per vaginal bleeding. Further evaluation revealed a second primary malignancy — moderately differentiated squamous cell carcinoma (SCC) of the cervix. Whole-body PET-CT demonstrated disease in the left breast, axillary lymph nodes, liver, omentum, cervix, uterus, and adnexa — suggestive of metastatic breast carcinoma with synchronous locally advanced cervical cancer.

Following multidisciplinary tumor board discussion, she was initiated on systemic chemotherapy with weekly Paclitaxel and Carboplatin for 18 cycles. Interim PET-CT showed a good systemic response with residual disease confined to the cervix.

She then received radical chemoradiotherapy using Tomotherapy with Synchrony^® technology, selected due to the large and irregular tumor volume. This advanced radiation technique provided excellent target coverage while sparing surrounding normal tissues. Despite the complexity of the tumor geometry, radiation delivery was successful with minimal side effects and good overall tolerance.

The treatment was completed with intracavitary brachytherapy to the residual cervical disease.

At the two-month post-radiotherapy follow-up, PET-CT demonstrated a complete metabolic response, with no evidence of residual or recurrent disease.

Discussion:

This case represents the therapeutic challenge of synchronous dual primary malignancies — combining metastatic breast cancer and locally advanced cervical cancer in the same patient. Treatment complexity was heightened due to:

• Prior incomplete management at another center,
• Large, irregular cervical tumor volume,
• The need to balance aggressive systemic and locoregional therapy while preserving

organ function and minimizing toxicity.

Use of Tomotherapy with Synchrony^® allowed precise, adaptive radiation delivery despite the large tumor burden, contributing to excellent disease control with minimal toxicity.

The case underscores the critical role of a multidisciplinary team, including medical oncology, radiation oncology, radiology, pathology, and supportive care specialists, in devising and executing an individualized, evidence-based treatment plan — ultimately resulting in an excellent clinical and radiological outcome.