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Methods: Systematic search of Medline, Embase, APA, PsycInfo, CAB abstracts, Scopus, and Web of Science from inception to June 30, 2024, including relevant patient studies. Results: 7917 studies found; 79 met inclusion criteria (62 case reports, 7 case series, 10 cohorts). Narrative synthesis categorized treatment by year, molecular subtype, histology, and staging; modality counts and response rates varied by subtype. Cohort analyses linked metastasis rate with radiotherapy use and chemotherapy with hormonal therapy. Median survival correlated with surgical treatment. Conclusions: Local treatment is essential for symptomatic palliation; histology should guide choices, while emerging systemic therapies may become first-line options. Source heterogeneity precluded 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was the main objective of the systematic review?","Question",{"text":113,"@type":114},"To identify optimal therapeutic strategies for managing fungating, large, or ulcerating breast tumors and to highlight gaps in existing literature.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How were studies selected and what was the final evidence base?",{"text":118,"@type":114},"A systematic search was conducted across multiple databases from inception to June 30, 2024, and 79 studies met inclusion criteria: 62 case reports, 7 case series, and 10 cohort studies.",{"name":120,"@type":111,"acceptedAnswer":121},"Why was a narrative synthesis used instead of a meta-analysis?",{"text":122,"@type":114},"High heterogeneity across sources prevented meta-analysis, so treatments were analyzed through a narrative synthesis and categorized by factors such as year, molecular subtype, histology, and staging.",{"name":124,"@type":111,"acceptedAnswer":125},"Which treatment elements showed positive correlations with outcomes in cohort analyses?",{"text":126,"@type":114},"Cohort analyses found positive correlations between metastasis rate and radiotherapy use, between chemotherapy and hormonal therapy use, and a positive correlation between median survival and surgical treatment.","https://schema.org",{"og:url":83,"og:type":129,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":131,"canonical":83},"index,follow",{"doc_id":133,"site_id":62},331734,1790546796,{"code":4,"msg":5,"data":136},{"doc_id":133,"user_id":137,"nickname":92,"user_avatar":138,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":139,"file_id":140,"file_url":141,"file_type":142,"file_size":143,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":105,"language":144,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":145,"faqs":146,"seo_title":147,"seo_description":67,"update_tm":148,"read_time":41},13056703020460,"https://ap-avatar.wpscdn.com/avatar/be000253dac470eee5d?_k=1778207105932848923","The Breast 79 (2025) 103870  \nContents lists available at ScienceDirect  \nThe Breast  \njournal [homepage:](homepage: www.journals.elsevier.com/the-breast)[ www.journals.elsevier.com/the-breast](homepage: www.journals.elsevier.com/the-breast)  \n| Therapeutic strategies for fungating and ulcerating breast cancers: A systematic review and narrative synthesis |  |  | |\n| --- | --- | --- | --- |\n| Valentina Zagardoa,1, Mandara Harikarb,1, Gianluca Ferinia,c,*\u003Cbr>a Radiation Oncology Unit, REM Radioterapia Srl, 95029, Viagrande, Italy b Clinical Trials Programme, The University of Edinburgh, United Kingdom c Department of Medicine and Surgery, University of Enna Kore, Enna, Italy |  |  |  |\n| A R T I C L E I N F O |  | A B S T R A C T |  |\n| Keywords:\u003Cbr>Fungating breast cancer radiotherapy Palliative therapy Ulcerating tumor Breast cancer |  | Background: To identify optimal therapeutic strategies for managing fungating, large or ulcerating breast tumorsand highlight existing gaps in the literature.\u003Cbr>Methods: We conducted a systematic search of Medline, Embase, APA, PsycInfo, CAB abstracts, Scopus, and Web of Science from inception to June 30, 2024, including studies on patients with fungating, large, or ulcerating breast cancers.\u003Cbr>Results: The search identified 7917 studies, with 79 meeting the inclusion criteria: 62 case reports, 7 case series, and 10 cohort studies. Owing to high heterogeneity, a narrative synthesis was performed, categorizing treatment by year, molecular subtype, histology, and staging. We found that treatment modalities increased, from an average of two in luminal-B cancers to three in HER2-positive cases, with over half achieving complete response. Triple-negative breast cancers averaged two modalities, with around half showing only partial response. Cohort analysis revealed a significant positive correlation between metastasis rate and radiotherapy use (Spearman’srho = 0.828, p = 0.042) and between chemotherapy and hormonal therapy use (rho = 0.69, p = 0.04). Median survival was positively correlated with surgical treatment (rho = 0.82, p = 0.046).\u003Cbr>Conclusions: Local treatment is crucial for symptomatic palliation in fungating or ulcerating breast tumors, and histology should guide therapeutic choices. While local treatments remain primary, emerging systemic therapies show promise and may soon become first-line options. As the first systematic review on this topic, our study faced considerable source heterogeneity, precluding a meta-analysis. Instead, we analyzed treatment trends by demographics and tumor characteristics, providing a comprehensive overview and encouraging further research in this area. |  |\n\n1. Introduction  \nFungating, large, or ulcerating breast wounds are a rare condition that occurs as an advanced and distressing consequence of breast cancer [1]. The occurrence of locally advanced disease (LABC), classified as AJCC Stage III as per the US National Comprehensive Cancer Network [2], is likely due to delays in breast cancer diagnosis, such as challenges in accessing outpatient care that were observed during the COVID-19 pandemic [3]. Additionally, healthcare delays may also be attributable to patients’ psychological unwillingness to accept their condition, low socioeconomic levels, social isolation, male gender, or elderly age [4]. This means that LABC can occur not only in developing countries but  \nalso in developed ones.  \nThe occurrence of LABC in the fungating or ulcerated form, here on referred to as “locally disfiguring breast cancer”, is a source of severe distress to patients owing to uncontrollable bleeding, recurring infections, foul smell, chronic pain, or aesthetic concerns [5]. Not only the primary tumor, but recurrences in the form of skin metastases can exhibit ulcerated and fungating features as well.  \nTherefore, given the limited life expectancy of these patients, the primary goal of fungating wound management is generally palliative, aiming to minimize symptoms an","cbCainxRUTbOyRou","https://ap.wps.com/l/cbCainxRUTbOyRou","pdf",2677758,"English","# Introduction\n## Fungating, large, or ulcerating breast wounds\n## Locally disfiguring breast cancer and clinical challenges\n## Goals of treatment: palliation and quality of life\n## Role of local and surgical options\n## Role of palliative radiation and emerging radiotherapy techniques","[{\"question\":\"What was the main objective of the systematic review?\",\"answer\":\"To identify optimal therapeutic strategies for managing fungating, large, or ulcerating breast tumors and to highlight gaps in existing literature.\"},{\"question\":\"How were studies selected and what was the final evidence base?\",\"answer\":\"A systematic search was conducted across multiple databases from inception to June 30, 2024, and 79 studies met inclusion criteria: 62 case reports, 7 case series, and 10 cohort studies.\"},{\"question\":\"Why was a narrative synthesis used instead of a meta-analysis?\",\"answer\":\"High heterogeneity across sources prevented meta-analysis, so treatments were analyzed through a narrative synthesis and categorized by factors such as year, molecular subtype, histology, and staging.\"},{\"question\":\"Which treatment elements showed positive correlations with outcomes in cohort analyses?\",\"answer\":\"Cohort analyses found positive correlations between metastasis rate and radiotherapy use, between chemotherapy and hormonal therapy use, and a positive correlation between median survival and surgical treatment.\"}]","Therapeutic strategies for fungating and ulcerating breast cancers - A systematic review and narrative synthesis | PDF",1789994931]