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Pisano CE, Kharouta MZ, Harris EE, Shenk R, Martin J, Owusu C, Lyons JA. Reduced-Dose Radiation Therapy and Concurrent Paclitaxel Chemotherapy in Lymph Node-Positive Breast Cancer: Long-Term Follow-up of a Single-Institution Prospective Study. Int J Radiat Oncol Biol Phys 2023; 117:883-886. [PMID: 37406825 DOI: 10.1016/j.ijrobp.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/23/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Courtney E Pisano
- Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, Clevleland, Ohio
| | - Michael Z Kharouta
- Department of Radiation Oncology, Advocate Illinois Masonic Creticos Cancer Center, Chicago, Illinois
| | - Eleanor E Harris
- Department of Radiation Oncology, St. Luke's University Health Network, Easton, Pennsylvania
| | - Robert Shenk
- Department of Surgery, University Hospitals, Cleveland Medical Center, Clevleland, Ohio
| | - James Martin
- Department of Hematology and Oncology, University Hospitals, Cleveland Medical Center, Clevleland, Ohio
| | - Cynthia Owusu
- Department of Hematology and Oncology, University Hospitals, Cleveland Medical Center, Clevleland, Ohio
| | - Janice A Lyons
- Department of Radiation Oncology, University Hospitals, Cleveland Medical Center, Clevleland, Ohio.
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Wheeler SB, Rotter JS, Baggett CD, Zhou X, Zagar T, Reeder-Hayes KE. Cost-effectiveness of endocrine therapy versus radiotherapy versus combined endocrine and radiotherapy for older women with early-stage breast cancer. J Geriatr Oncol 2021; 12:741-748. [PMID: 33558179 DOI: 10.1016/j.jgo.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/25/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the cost-effectiveness of endocrine therapy (ET), radiation therapy (XRT), and combination ET + XRT as post-surgical treatment for older women with early-stage breast cancer from the societal perspective. METHODS We constructed a Markov state-transition model consisting of three mutually exclusive health-states: Disease-Free, Recurrence, or Death. Osteoporotic fracture, radiation-induced breast fibrosis, and radiation pneumonitis were modeled as treatment-related adverse events (AEs). Cancer registry-linked-Medicare data were used to assess probability of recurrence and total costs, after propensity adjustment to account for treatment selection, among women aged >65 years diagnosed with estrogen receptor positive or progesterone receptor positive (ER+/PR+) breast cancer receiving ET, XRT, or ET + XRT in 2007-2011. Following randomized controlled trials, overall survival was assumed equivalent, but locoregional recurrence varied. Indirect costs and health-state utilities were literature-driven and varied in sensitivity analyses. Costs and outcomes were discounted at 3% annually. RESULTS In a cohort of 10,000 women over ten years, we estimated 1620 total recurrences in the ET-only group, 1296 in the XRT-only group, and 1076 with ET + XRT. Compared to ET-only, the base-case incremental cost-effectiveness ratio (ICER) was $10,826 per quality-adjusted life-year (QALY)-gained for XRT-only and $26,834/QALY-gained for ET + XRT. Similarities in cost and effectiveness between treatments led to highly sensitive results. We also present clinically-relevant patient preference scenarios for recurrence risk-averse patients and near-term AE risk-averse patients. CONCLUSIONS The cost-effectiveness of regimens including ET and/or XRT in older women with early-stage breast cancer is sensitive to small differences in costs, as well as risk of, and utilities associated with, locoregional recurrence, suggesting that patient preferences concerning treatment benefits and risks should be considered by physicians.
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Affiliation(s)
- Stephanie B Wheeler
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, USA; Lineberger Comprehensive Cancer Center, UNC, USA.
| | - Jason S Rotter
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, USA
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center, UNC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, USA
| | - Xi Zhou
- Lineberger Comprehensive Cancer Center, UNC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, USA
| | - Timothy Zagar
- Department of Radiation Oncology, UNC School of Medicine, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, UNC, USA; Division of Hematology/Oncology, UNC School of Medicine, USA
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Chandra RA, Taghian AG. In Reply to Lawrence. Int J Radiat Oncol Biol Phys 2015; 93:215-6. [DOI: 10.1016/j.ijrobp.2015.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 11/28/2022]
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Mandilaras V, Bouganim N, Spayne J, Dent R, Arnaout A, Boileau JF, Brackstone M, Meterissian S, Clemons M. Concurrent chemoradiotherapy for locally advanced breast cancer-time for a new paradigm? ACTA ACUST UNITED AC 2015; 22:25-32. [PMID: 25684986 DOI: 10.3747/co.21.2043] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In cases of locally advanced breast cancer (labc), preoperative ("neoadjuvant") therapy was traditionally reserved to render the patient operable. More recently, neoadjuvant therapy, particularly chemotherapy, is being used in patients with operable disease to increase the opportunity for breast conservation. Despite the increasing use of preoperative chemotherapy, rates of pathologic complete response, a surrogate marker for disease-free survival, remain modest in patients with locally advanced disease and particularly so when the tumour is estrogen or progesterone receptor-positive and her2-negative. A new paradigm for labc patients is needed. In other solid tumours (for example, rectal, esophageal, and lung cancers), concurrent chemoradiotherapy (ccrt) is routinely used in neoadjuvant and adjuvant treatment protocols alike. RESULTS The literature suggests that ccrt in labc patients with inoperable disease is associated with response rates higher than would be anticipated with systemic therapy alone. CONCLUSIONS Ongoing trials in this field are eagerly awaited to determine if ccrt should become the new paradigm.
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Affiliation(s)
- V Mandilaras
- Department of Medical Oncology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC
| | - N Bouganim
- Department of Medical Oncology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC
| | - J Spayne
- Division of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - R Dent
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - A Arnaout
- Ottawa Hospital Cancer Centre and Ottawa Hospital Research Institute, Ottawa, ON
| | - J F Boileau
- Department of Oncology, Jewish General Hospital and Segal Cancer Centre, Montreal, QC
| | - M Brackstone
- London Regional Cancer Program, Division of General Surgery/Surgical Oncology, London, ON
| | - S Meterissian
- Department of Surgical Oncology, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC
| | - M Clemons
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
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Abstract
BACKGROUND After surgery for localised breast cancer, radiotherapy (RT) improves both local control and breast cancer-specific survival. In patients at risk of harbouring micro-metastatic disease, adjuvant chemotherapy (CT) improves 15-year survival. However, the best sequence of administering these two types of adjuvant therapy for early-stage breast cancer is unclear. OBJECTIVES To determine the effects of different sequencing of adjuvant CT and RT for women with early breast cancer. SEARCH METHODS An updated search was carried out in the Cochrane Breast Cancer Group's Specialised Register (20 May 2011), MEDLINE (14 December 2011), EMBASE (20 May 2011) and World Health Organization (WHO) International Clinical Trials Registry Platform (20 May 2011). Details of the search strategy and methods of coding for the Specialised Register are described in the Group's module in The Cochrane Library. We extracted studies that had been coded as 'early', 'chemotherapy' and 'radiotherapy'. SELECTION CRITERIA We included randomised controlled trials evaluating different sequencing of CT and RT. DATA COLLECTION AND ANALYSIS We assessed the eligibility and quality of the identified studies and extracted data from the published reports of the included trials. We derived odds ratios (OR) and hazard ratios (HR) from the available numerical data. Toxicity data were extracted, where reported. We used a fixed-effect model for meta-analysis and conducted analyses on the basis of the method of sequencing of the two treatments. MAIN RESULTS Three trials reporting two different sequencing comparisons were identified. There were no significant differences between the various methods of sequencing adjuvant therapy for local recurrence-free survival, overall survival, relapse-free survival and metastasis-free survival based on 1166 randomised women in three trials. Concurrent chemoradiation increased anaemia (OR 1.54; 95% confidence interval (CI) 1.10 to 2.15), telangiectasia (OR 3.85; 95% CI 1.37 to 10.87) and pigmentation (OR 15.96; 95% CI 2.06 to 123.68). Treated women did not report worse cosmesis with concurrent chemoradiation but physician-reported assessments did (OR 1.14; 95% CI 0.42 to 3.07). Other measures of toxicity did not differ between the two types of sequencing. On the basis of one trial (244 women), RT before CT was associated with an increased risk of neutropenic sepsis (OR 2.96; 95% CI 1.26 to 6.98) compared with CT before RT, but other measures of toxicity did not differ. AUTHORS' CONCLUSIONS The data included in this review, from three well-conducted randomised trials, suggest that different methods of sequencing CT and RT do not appear to have a major effect on recurrence or survival for women with breast cancer if RT is commenced within seven months after surgery.
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Affiliation(s)
- Brigid E Hickey
- Radiation Oncology Mater Service, Princess Alexandra Hospital, Brisbane, Australia.
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Chen WC, Kim J, Kim E, Silverman P, Overmoyer B, Cooper BW, Anthony S, Shenk R, Leeming R, Hanks SH, Lyons JA. A phase II study of radiotherapy and concurrent paclitaxel chemotherapy in breast-conserving treatment for node-positive breast cancer. Int J Radiat Oncol Biol Phys 2010; 82:14-20. [PMID: 21035961 DOI: 10.1016/j.ijrobp.2010.08.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 08/03/2010] [Accepted: 08/17/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Administering adjuvant chemotherapy before breast radiotherapy decreases the risk of systemic recurrence, but delays in radiotherapy could yield higher local failure. We assessed the feasibility and efficacy of placing radiotherapy earlier in the breast-conserving treatment course for lymph node-positive breast cancer. METHODS AND MATERIALS Between June 2000 and December 2004, 44 women with node-positive Stage II and III breast cancer were entered into this trial. Breast-conserving surgery and 4 cycles of doxorubicin (60 mg/m(2))/cyclophosphamide (600 mg/m(2)) were followed by 4 cycles of paclitaxel (175 mg/m(2)) delivered every 3 weeks. Radiotherapy was concurrent with the first 2 cycles of paclitaxel. The breast received 39.6 Gy in 22 fractions with a tumor bed boost of 14 Gy in 7 fractions. Regional lymphatics were included when indicated. Functional lung volume was assessed by use of the diffusing capacity for carbon monoxide as a proxy. Breast cosmesis was evaluated with the Harvard criteria. RESULTS The 5-year actuarial rate of disease-free survival is 88%, and overall survival is 93%. There have been no local failures. Median follow-up is 75 months. No cases of radiation pneumonitis developed. There was no significant change in the diffusing capacity for carbon monoxide either immediately after radiotherapy (p = 0.51) or with extended follow-up (p = 0.63). Volume of irradiated breast tissue correlated with acute cosmesis, and acute Grade 3 skin toxicity developed in 2 patients. Late cosmesis was not adversely affected. CONCLUSIONS Concurrent paclitaxel chemotherapy and radiotherapy after breast-conserving surgery shortened total treatment time, provided excellent local control, and was well tolerated.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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Bese N. Radiochemotherapy in the Treatment of Breast Cancer. Clin Oncol (R Coll Radiol) 2009; 21:532-5. [DOI: 10.1016/j.clon.2009.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 04/23/2009] [Indexed: 01/27/2023]
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Haffty BG, Vicini FA, Beitsch P, Quiet C, Keleher A, Garcia D, Snider H, Gittleman M, Zannis V, Kuerer H, Whitacre E, Whitworth P, Fine R, Keisch M. Timing of Chemotherapy After MammoSite Radiation Therapy System Breast Brachytherapy: Analysis of the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial. Int J Radiat Oncol Biol Phys 2008; 72:1441-8. [PMID: 18692330 DOI: 10.1016/j.ijrobp.2008.02.070] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 02/28/2008] [Accepted: 02/29/2008] [Indexed: 11/25/2022]
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9
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Concurrent Cyclophosphamide, Methotrexate, and 5-Fluorouracil Chemotherapy and Radiotherapy for Early Breast Carcinoma. Int J Radiat Oncol Biol Phys 2008; 71:705-9. [DOI: 10.1016/j.ijrobp.2007.10.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 10/24/2007] [Accepted: 10/24/2007] [Indexed: 11/19/2022]
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Piroth MD, Pinkawa M, Gagel B, Stanzel S, Asadpour B, Eble MJ. Sequencing chemotherapy and radiotherapy in locoregional advanced breast cancer patients after mastectomy - a retrospective analysis. BMC Cancer 2008; 8:114. [PMID: 18433485 PMCID: PMC2377278 DOI: 10.1186/1471-2407-8-114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 04/23/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Combined chemo- and radiotherapy are established in breast cancer treatment. Chemotherapy is recommended prior to radiotherapy but decisive data on the optimal sequence are rare. This retrospective analysis aimed to assess the role of sequencing in patients after mastectomy because of advanced locoregional disease. METHODS A total of 212 eligible patients had a stage III breast cancer and had adjuvant chemotherapy and radiotherapy after mastectomy and axillary dissection between 1996 and 2004. According to concerted multi-modality treatment strategies 86 patients were treated sequentially (chemotherapy followed by radiotherapy) (SEQgroup), 70 patients had a sandwich treatment (SW-group) and 56 patients had simultaneous chemoradiation (SIM-group) during that time period. Radiotherapy comprised the thoracic wall and/or regional lymph nodes. The total dose was 45-50.4 Gray. As simultaneous chemoradiation CMF was given in 95.4% of patients while in sequential or sandwich application in 86% and 87.1% of patients an anthracycline-based chemotherapy was given. RESULTS Concerning the parameters nodal involvement, lymphovascular invasion, extracapsular spread and extension of the irradiated region the three treatment groups were significantly imbalanced. The other parameters, e.g. age, pathological tumor stage, grading and receptor status were homogeneously distributed. Looking on those two groups with an equally effective chemotherapy (EC, FEC), the SEQ- and SW-group, the sole imbalance was the extension of LVI (57.1 vs. 25.6%, p < 0.0001).5-year overall- and disease free survival were 53.2%/56%, 38.1%/32% and 64.2%/50%, for the sequential, sandwich and simultaneous regime, respectively, which differed significantly in the univariate analysis (p = 0.04 and p = 0.03, log-rank test). Also the 5-year locoregional or distant recurrence free survival showed no significant differences according to the sequence of chemo- and radiotherapy. In the multivariate analyses the sequence had no independent impact on overall survival (p = 0.2) or disease free survival (p = 0.4). The toxicity, whether acute nor late, showed no significant differences in the three groups. The grade III/IV acute side effects were 3.6%, 0% and 3.5% for the SIM-, SW- and SEQ-group. By tendency the SIM regime had more late side effects. CONCLUSION No clear advantage can be stated for any radio- and chemotherapy sequence in breast cancer therapy so far. This could be confirmed in our retrospective analysis in high-risk patients after mastectomy. The sequential approach is recommended according to current guidelines considering a lower toxicity.
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Affiliation(s)
- Marc D Piroth
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Bernd Gagel
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Sven Stanzel
- Institute of Medical Statistics, RWTH Aachen University Hospital, Aachen, Germany
| | - Branka Asadpour
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University Hospital, Aachen, Germany
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11
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Yom CK, Kim HA, Moon BI, Choe KJ, Choi KJ, Suh HS, Choi HY. Toxicity of Concurrent Adjuvant CMF Chemotherapy and Radiotherapy in Patients with Early Breast Cancer. J Breast Cancer 2007. [DOI: 10.4048/jbc.2007.10.2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Cha-Kyong Yom
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Byung-In Moon
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kuk-Jin Choe
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kum-Ja Choi
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyun-Suk Suh
- Department of Therapeutic Radiology & Oncology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye-Young Choi
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
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12
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Haffty BG, Kim JH, Yang Q, Higgins SA. Concurrent chemo-radiation in the conservative management of breast cancer. Int J Radiat Oncol Biol Phys 2006; 66:1306-12. [PMID: 16750318 DOI: 10.1016/j.ijrobp.2006.03.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 03/09/2006] [Accepted: 03/16/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE Sequencing of chemotherapy (CTX) with radiation (RT) in the conservative management of breast cancer (CS+RT) remains controversial. We report here the results of a retrospective analysis of all patients treated with CTX and RT, with specific focus on outcome as a function of sequencing of CTX with RT. METHODS AND MATERIALS A total of 535 patients treated with CS+RT received CTX as a component of therapy. RT was administered concurrently with CTX in 109 (CONCTX). CTX was administered before RT in 276 patients, after RT in 106 patients, and in "sandwich" fashion in 44 patients. These three groups comprise the sequential chemotherapy group (SEQCTX). RESULTS With follow-up of 8.8 years, the 10-year survival rate was 78% and the distant metastasis-free rate was 75%. Despite more adverse factors for local control, patients in the CONCTX group had superior local control rate of 92% at 10 years compared with 83% in the SEQCTX group (p < 0.001). In multivariate analysis, CONCTX was associated with a significant improvement in local control (HR = 0.338, 95% CI = 0.141-0.809, p = 0.015). Cosmetic results, toxicities, and long-term complications were acceptable using this CONCTX regimen. CONCLUSIONS CONCTX was associated with a reduction in local relapse rates, acceptable cosmesis, and toxicities. These data support the use of concurrent RT and CTX in selected patients at high risk for local failure. Future prospective trials should explore the use of concurrent CTX and RT in high-risk patients using currently employed agents.
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Affiliation(s)
- Bruce G Haffty
- Department of Radiation Oncology UMDNJ-Robert Wood Johnson Medical School and the Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA.
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13
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Hickey BE, Francis D, Lehman MH. Sequencing of chemotherapy and radiation therapy for early breast cancer. Cochrane Database Syst Rev 2006:CD005212. [PMID: 17054248 DOI: 10.1002/14651858.cd005212.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND After surgery for localised breast cancer, adjuvant radiotherapy improves both local control and breast cancer specific survival. In patients at risk of harbouring micro-metastatic disease, adjuvant chemotherapy improves 15-year survival. However, the best sequence of administering these two types of adjuvant therapy for early stage breast cancer is not clear. OBJECTIVES To determine the effects of different sequencing of chemotherapy and radiotherapy for women with early breast cancer. SEARCH STRATEGY We searched the Cochrane Breast Cancer Group Specialized Register (10 March 2005). Details of the search strategy and methods of coding are described in the Group's module in The Cochrane Library. We extracted studies that had been coded as 'early', 'chemotherapy' and 'radiotherapy'. SELECTION CRITERIA Randomised controlled trials evaluating different sequencing of chemotherapy and radiotherapy were included. DATA COLLECTION AND ANALYSIS We assessed the eligibility and quality of the identified studies and extracted data from the published reports of the included studies. We derived odds ratios (OR) and risk ratios from the available numerical data. Hazard ratios were extracted directly from text. Toxicity data were extracted, where reported. We used a fixed-effect model for meta-analysis and conducted analyses on the basis of the method of sequencing of the two treatments. MAIN RESULTS Three trials reporting two different sequencing comparisons were identified. There were no significant differences between the various methods of sequencing adjuvant therapy for survival, distant metastases or local recurrence, based on 853 randomised patients in two trials. One of these two trials (647 women) provided data on toxicity. Haematological toxicity (OR 1.43, confidence interval (CI) 1.01 to 2.03) and oesophageal toxicity (OR 1.44, CI 1.03 to 2.02) were significantly increased with concurrent therapy, and nausea and vomiting were significantly decreased (OR 0.70, CI 0.50 to 0.98). Other measures of toxicity did not differ between the two types of sequencing. On the basis of one trial (244 women), radiotherapy before chemotherapy was associated with a significantly increased risk of neutropenic sepsis (OR 2.96, 95% CI 1.26 to 6.98) compared with chemotherapy before radiotherapy, but other measures of toxicity were not significantly different. AUTHORS' CONCLUSIONS The data included in this review, from three well conducted randomised trials, suggest that different methods of sequencing chemotherapy and radiotherapy do not appear to have a major effect on survival or recurrence for women with breast cancer if radiation therapy is commenced within 7 months after surgery.
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Affiliation(s)
- B E Hickey
- Queensland Radium Institute Mater Centre, Southern Zone Oncology Service, Raymond Terrace, Brisbane, QLD, Australia.
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Bowden SJ, Fernando IN, Burton A. Delaying Radiotherapy for the Delivery of Adjuvant Chemotherapy in the Combined Modality Treatment of Early Breast Cancer: Is It Disadvantageous and Could Combined Treatment be the Answer? Clin Oncol (R Coll Radiol) 2006; 18:247-56. [PMID: 16605056 DOI: 10.1016/j.clon.2005.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Women with early stage breast cancer are increasingly being treated with both adjuvant chemotherapy and radiotherapy. The optimal sequence of these two treatment modalities is yet to be defined. It remains controversial whether delaying radiotherapy in order to deliver chemotherapy compromises local disease control and survival. Consequently, clinical practice in the UK is divided, with a number of different combination schedules being used in an effort to bring forward the start of radiotherapy. In practice, however, any benefit in local control must be balanced against a potential increase in toxicity. A review of the current literature on the effect of radiotherapy delay is presented, together with data on the toxicity of combined chemo-radiotherapy schedules and recent data from clinical trials designed to determine the optimal sequencing of chemotherapy and radiotherapy.
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Affiliation(s)
- S J Bowden
- CR UK Clinical Trials Unit, Institute for Cancer Studies, The University of Birmingham, Edgbaston, Birmingham, UK.
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Abstract
Over the past five decades, radiotherapy (RT) has become an integral part in the combined modality management of breast cancer. Although its significant effect on local control has been long demonstrated, only recently has adjuvant RT been shown to have a significant effect on breast cancer mortality and overall survival. This article summarizes the adjuvant role of RT after mastectomy and lumpectomy, as well as the rationale and techniques for partial-breast irradiation.
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Affiliation(s)
- Jennifer R Bellon
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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16
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Arcangeli G, Pinnarò P, Rambone R, Giannarelli D, Benassi M. A phase III randomized study on the sequencing of radiotherapy and chemotherapy in the conservative management of early-stage breast cancer. Int J Radiat Oncol Biol Phys 2005; 64:161-7. [PMID: 16226397 DOI: 10.1016/j.ijrobp.2005.06.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 06/03/2005] [Accepted: 06/06/2005] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare two different timings of radiation treatment in patients with breast cancer who underwent conservative surgery and were candidates to receive adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy. METHODS AND MATERIALS A total of 206 patients who had quadrantectomy and axillary dissection for breast cancer and were planned to receive adjuvant CMF chemotherapy were randomized to concurrent or sequential radiotherapy. Radiotherapy was delivered only to the whole breast through tangential fields to a dose of 50 Gy in 20 fractions over 4 weeks, followed by an electron boost of 10-15 Gy in 4-6 fractions to the tumor bed. RESULTS No differences in 5-year breast recurrence-free, metastasis-free, disease-free, and overall survival were observed in the two treatment groups. All patients completed the planned radiotherapy. No evidence of an increased risk of toxicity was observed between the two arms. No difference in radiotherapy and in the chemotherapy dose intensity was observed in the two groups. CONCLUSIONS In patients with negative surgical margins receiving adjuvant chemotherapy, radiotherapy can be delayed to up to 7 months. Concurrent administration of CMF chemotherapy and radiotherapy is safe and might be reserved for patients at high risk of local recurrence, such as those with positive surgical margins or larger tumor diameters.
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Goldhirsch A, Glick JH, Gelber RD, Coates AS, Thürlimann B, Senn HJ. Meeting Highlights: International Expert Consensus on the Primary Therapy of Early Breast Cancer 2005. Ann Oncol 2005; 16:1569-83. [PMID: 16148022 DOI: 10.1093/annonc/mdi326] [Citation(s) in RCA: 750] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The ninth St Gallen (Switzerland) expert consensus meeting in January 2005 made a fundamental change in the algorithm for selection of adjuvant systemic therapy for early breast cancer. Rather than the earlier approach commencing with risk assessment, the Panel affirmed that the first consideration was endocrine responsiveness. Three categories were acknowledged: endocrine responsive, endocrine non-responsive and tumors of uncertain endocrine responsiveness. The three categories were further divided according to menopausal status. Only then did the Panel divide patients into low-, intermediate- and high-risk categories. It agreed that axillary lymph node involvement did not automatically define high risk. Intermediate risk included both node-negative disease (if some features of the primary tumor indicated elevated risk) and patients with one to three involved lymph nodes without additional high-risk features such as HER 2/neu gene overexpression. The Panel recommended that patients be offered chemotherapy for endocrine non-responsive disease; endocrine therapy as the primary therapy for endocrine responsive disease, adding chemotherapy for some intermediate- and all high-risk groups in this category; and both chemotherapy and endocrine therapy for all patients in the uncertain endocrine response category except those in the low-risk group.
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Affiliation(s)
- A Goldhirsch
- International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Pavlak M, Stojković R, Radacić-Aumiler M, Kasnar-Samprec J, Jercić J, Vlahović K, Zinić B, Radacić M. Antitumor activity of novel N-sulfonylpyrimidine derivatives on the growth of anaplastic mammary carcinoma in vivo. J Cancer Res Clin Oncol 2005; 131:829-36. [PMID: 16158306 DOI: 10.1007/s00432-005-0026-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 07/04/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate in vivo antitumor activity of newly synthesized N-sulfonylpyrimidine derivatives 1-(p-toluenesulfonyl)cytosine (4H), 1-(p-toluenesulfonyl)cytosine hydrochloride (4HxHCl) and zinc(II) complex of 1-(p-toluenesulfonyl)cytosine (4K). MATERIALS AND METHODS In order to do that we have used mouse anaplastic mammary carcinoma (AMCa). Tumor cells (10(6)) in a volume of 0.02 ml were transplanted into the thigh of the right hind leg of CBA mice. All compounds were dissolved in distilled water immediately before injecting to animals. RESULTS Antitumor effect of these compounds depends on drug doses and time interval between tumor transplantation and drug application. Further the efficacy of these compounds depends on number of drug injections, i. e. whether drug was given in single or in multiple doses. Multiple doses of 400 mg/kg of 1-(p-toluenesulfonyl)cytosine (4H) showed good antitumor effect when applied on day 1, 3, 5, 7 and 9 after tumor transplantation. Still good but slightly lower antitumor effect was also achieved when that compound was given in a single dose (1,200 mg/kg) on day 1 after tumor transplantation. The longest period of tumor growth time was obtained after application of 1-(p-toluenesulfonyl)cytosine hydrochloride (4HxHCl) given as a single dose (300 mg/kg) on day 1 or on day 6 after tumor implantation. However, antitumor effect of zinc(II) complex of 1-(p-toluenesulfonyl)cytosine (4K) was very strong when 300 mg/kg was given on day 1 or day 6, while this effect was slightly lower when drug (200 mg/kg/inj) was given on day 1, 3, 5, 7 and 9 or on day 6, 8, 10, 12 and 14. CONCLUSION In this work it has been found that N-1-sulfonylcytosine derivatives have strong antitumor activity against mouse mammary carcinoma which is a good reason for further research of these compounds both in experimental and preclinical studies.
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Affiliation(s)
- Marina Pavlak
- Department of Biology, Faculty of Veterinary Medicine, Zagreb University, Heinzelova 55, 10000, Zagreb, Croatia.
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Bellon JR, Harris JR. Chemotherapy and Radiation Therapy for Breast Cancer: What Is the Optimal Sequence? J Clin Oncol 2005; 23:5-7. [PMID: 15545662 DOI: 10.1200/jco.2005.09.962] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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