In this retrospective analysis of 101 patients with MFW treated with RT, we observed high rates of clinical benefit. A total of 85% of patients achieved the predefined therapeutic goal, over 80% experienced tumor reduction and symptom improvement, and RT-related toxicity was generally mild. Concurrent chemotherapy and a lower CCI were significantly associated with improved outcomes and OS. Despite the heterogeneity of tumor types, treatment intent, and RT regimens, our results underscore the potential of RT—either alone or in combination with systemic therapy—for local tumor control and symptom relief in patients with MFW.

The most frequent tumor entities in our cohort were breast cancer, cutaneous squamous cell carcinoma, and vulvar cancer. This distribution is consistent with previous studies, such as Kondra et al., who reported a predominance of breast cancer (55%), SCC (25%), and sarcoma (9%) in a similar patient population [17]. Maida et al. likewise found breast cancer to be the most common cause of MFW, followed by gastrointestinal and lung cancers [5]. In our cohort, the most common anatomical locations were the head and neck, followed by the breast/chest wall and genitals—findings that are comparable to earlier reports. A majority of patients (65.3%) were female, reflecting the high incidence of breast cancer-associated MFW. This gender distribution aligns with existing literature on malignant wounds [5, 17, 18].

The achievement of a treatment-related therapy goal, as defined in Sect. 2.2, was observed in 85% of patients. Our composite endpoint aimed to incorporate both objective parameters (e.g., Haisfield-Wolfe and Baxendale-Cox wound stages [15]) and subjective outcomes (e.g., pain relief), thus enabling a structured yet clinically relevant assessment in both curative and palliative settings. Nevertheless, the use of such a surrogate endpoint introduces interpretation limitations and reduces comparability with other studies. Generally, comparisons with the literature are hampered by the limited number of studies on RT in MFW, particularly outside of breast cancer. Nakamura et al. conducted a prospective study on 21 patients with breast cancer and skin invasion, demonstrating significant symptom relief but no improvement in pain or quality of life (QoL), possibly due to low baseline pain levels and disease progression outside the RT field [12]. Chia et al. reported symptom improvement in 94% of patients with ulcerated breast cancer, with a partial remission in 46% and stable disease in 48% [13]. In our study, local progression or recurrence occurred in 30.7% of patients, with a median time to progression of 4 months—somewhat shorter than the 6–10 months reported by Chia et al. and Nakamura et al. [12, 13].

Concomitant chemotherapy significantly increased the likelihood of achieving the therapy goal (p = 0.044). The benefit of combining RT and chemotherapy has been previously demonstrated for local tumor response and OS, particularly in patients with good performance status [19, 20]. In our cohort, RCT was more frequently used in curative settings (41.9%) than in palliative ones (10%), reflecting individualized treatment decisions tailored to patient condition and treatment intent. Although some studies report increased toxicity with RCT, this was not observed in our cohort—potentially due to careful patient selection and heterogeneous regimens [21]. These findings support a context-dependent use of concurrent RCT in both curative and palliative scenarios [22].

RT-related toxicity was generally mild: 73.3% of patients experienced any adverse event, with grade 1–2 dermatitis occurring in 58.6% and grade 3 dermatitis in 6.9%. Only two patients discontinued RT due to toxicity. These results are comparable to previous findings, such as those of Jacobson et al., who reported grade 1–2 dermatitis in 90% of patients, and Chia et al., who documented no grade ≥ 3 toxicities [10, 13]. Similarly, Nakamura et al. reported grade 2 dermatitis in one patient and grade 3 in two patients (10%) [12]. Prior RT at the same site did not appear to increase toxicity in our cohort, consistent with the findings of Jacobson et al. [10].

Interestingly, total dose and fractionation did not correlate with therapy goal achievement or OS. Most patients (59.4%) received normofractionated RT with 1.8–2 Gy per fraction, even in palliative settings. Hypofractionated schemes were more frequently used in recent years, reflecting evolving practice patterns and recommendations favoring shorter courses in patients with limited life expectancy [22,23,24]. Among non-responders, seven patients showed no clinical benefit, while four experienced disease progression despite initial response. The relatively high local recurrence rate (30.7%) underscores the aggressive nature of MFW and the importance of tailored treatment strategies.

Median OS in our cohort was 7.8 months from the start of RT, with 39.5% of patients alive at 12 months. Achievement of the therapy goal, concurrent chemotherapy, and lower CCI were all associated with improved survival. These findings are consistent with the established prognostic value of comorbidity burden and suggest that local tumor control—captured here through goal achievement—may reduce morbidity and, indirectly, mortality. While survival benefits from concurrent chemotherapy were evident primarily in curatively treated patients, the data support its potential use in selected palliative cases as well [21, 25].

This retrospective study analyzed a cohort of 101 patients with MFW treated with RT at a tertiary academic oncology center between January 2000 and June 2022. We evaluated the achievement of predefined therapeutic goals, wound improvement, oncological outcomes, and factors influencing treatment success. The main limitations of this study include its retrospective design, the heterogeneity of primary tumor types, and variability in treatment regimens, including different fractionation schedules and RT techniques. In addition, QoL data were not systematically collected.

Despite these limitations, the primary treatment goal—defined as reduction of tumor burden, bleeding control, pain relief, and overall wound improvement—was achieved in 85% of patients, with acceptably low toxicity. Concurrent chemotherapy was significantly associated with goal achievement and, along with a lower CCI, was also linked to improved overall survival.

To our knowledge, this is the largest cohort of patients with MFW treated with RT reported to date. These findings highlight the relevance of RT as an effective component of multimodal management strategies in both curative and palliative settings, contributing to local tumor control and potentially improving patients’ QoL.