{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:03:42Z","timestamp":1790053422439,"version":"4.0.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Giant ulcerative breast cancers (&amp;gt;2,000 cc) with active hemorrhage present a critical therapeutic challenge, as conventional radiotherapy carries a high risk of severe toxicity to surrounding organs. Lattice radiotherapy (LRT) delivers spatially fractionated high-dose vertices within a low-dose background, offering the potential to overcome dose constraints. However, rapid tumor regression induced by LRT may render fixed plans unsafe, necessitating adaptive replanning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 46-year-old female with stage IV triple-negative breast cancer (TNBC; BRCA1 germline mutation) presented with a 2,772.2-cc ulcerative left breast and axillary masses complicated by persistent hemorrhage, recurrent infection, and Eastern Cooperative Oncology Group (ECOG 3). After failure of systemic therapies including fluzoparib, image-guided adaptive LRT was initiated (gross tumor volume [GTV]: 12 Gy\/4 fractions; lattice vertices: 60 Gy\/4 fractions). Before fractions 2\u20134, the GTV was re-contoured on daily fan-beam computed tomography (FBCT), lattice vertices were redistributed away from the skin surface, and plans were recalculated. LRT was followed by conventionally fractionated VMAT (40 Gy\/20 fractions). Hemorrhage ceased within 2 weeks and persistent fever subsided, becoming intermittent and progressively less frequent. Tumor volume progressively decreased by 21.2% during LRT (before fraction 4), 81.5% post-VMAT, and 96.1% (108.3 cc residual) at 2-month follow-up. Cumulative organ-at-risk (OAR) doses, estimated by rigid-registration dose accumulation, remained within tolerance, with only Grade 2 dermatitis and no \u2265Grade 3 toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates the technical feasibility of image-guided adaptive lattice replanning in a rapidly changing, ultra-large fungating breast tumor. Adaptive replanning may reduce geometric displacement of high-dose vertices; however, its dosimetric and clinical benefits require confirmation in further patients and with longer follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1942852","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:22:31Z","timestamp":1790050951000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Image-guided adaptive lattice radiotherapy for a 2,772-cc ulcerative triple-negative breast cancer"],"prefix":"10.3389","volume":"16","author":[{"given":"Min","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Hankou Hospital Affiliated with Wuhan University of Science and Technology (Wuhan Hankou Hospital)","place":["Wuhan, Hubei, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingna","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Hankou Hospital Affiliated with Wuhan University of Science and Technology (Wuhan Hankou Hospital)","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.33763","article-title":"Fungating breast wound: a rare manifestation of primary breast leiomyosarcoma","volume":"15","author":"Os\u00f3rio","year":"2023","journal-title":"Cureus"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2020.11.031","article-title":"Frequency and management of hemorrhagic Malignant wounds: a retrospective, single-center, observational study","volume":"62","author":"Nicod\u00e8me","year":"2021","journal-title":"J Pain Symptom 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