OK to start radiation therapy within 7 mos of surgery as

[Lani]

long as receiving adjuvant chemo/hormonal/immunotherapy in interim

Order of Chemotherapy, Radiation Has No Effect on Breast Cancer Survival [Center for the Advancement of Health]
For women who have had surgery for early breast cancer, it may not matter whether they receive follow-up chemotherapy before, after or during radiation therapy, according to a new review of studies.

A woman's chances of survival or seeing the cancer return are similar in all three cases, if radiation therapy and chemotherapy begin within seven months after surgery, the review concludes.

However, the studies suggest that certain toxic side effects in the blood and esophagus — common in chemotherapy and radiation patients — may be up to 44 percent more likely when the two therapies are delivered at the same time, said Dr. Brigid Hickey and colleagues at the Southern Zone Radiation Oncology Service in Brisbane, Australia.

The reviewers also note that most of the women in the studies were treated about 10 years ago. "As a result, the trials do not assess the modern types of radiotherapy and newer types of chemotherapy" and other anti-cancer drugs such as Herceptin, Hickey said.

Studies show that radiation therapy can reduce the risk of breast cancer returning in the treated breast and boost the likelihood of survival after breast cancer surgery. Doctors may also prescribe chemotherapy to women at high risk for having the cancer spread to other parts of the body after surgery, to reduce the risk of dying from breast cancer.

"However, the best sequence of administering these two types of therapy for early stage breast cancer is not clear," Hickey said.
"The delivery of chemotherapy first allows patients to continue with their treatment while they wait for radiotherapy to start, and this may make management of the waiting lists for radiotherapy easier," Hickey said.

Whelan said his clinical practice usually gives chemotherapy first followed by radiation. His practice follows a suggestion from an earlier study and "a clinical impression" that giving chemotherapy first reduces the risk that the cancer will reappear in a distant part of the body. But Whelan acknowledged that the risk of recurring cancer in the breast may be slightly higher when radiation is delayed.