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.

[Lani]

"As far as I know, there are few good randomized trials evaluating the different timing of radiation. This is one of the problems about deciding on what the best approach is here," said Dr. Tim Whelan, a radiation oncologist who specializes in breast cancer treatment at McMaster University in Ontario, Canada.

Hickey and colleagues found only three high-quality studies, comprising 1,097 patients, that compared different sequences of radiation and chemotherapy after breast cancer surgery.

The finding may reassure those who begin chemotherapy while waiting for radiation treatment, which is limited in many parts of the world, the Cochrane researchers said.

[Lani]

ABSTRACT: Sequencing of chemotherapy and radiation therapy for early breast cancer
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.

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'.

Randomised controlled trials evaluating different sequencing of chemotherapy and radiotherapy were included.

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.

[Lani]

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.

I hope by posting this for many to see, that this will enable those who live in countries with long waits for radiation therapy to rest assured that as far as they can figure out at the moment this will not end up being to their detriment.

[Bev]

Thanks Lani, BB