Background
There may be a relationship between the incidence of vasomotor and arthralgia/myalgia symptoms and treatment outcomes for postmenopausal breast cancer patients with endocrine-responsive disease who received adjuvant letrozole or tamoxifen.
Patients and methods
Data on patients randomized into the monotherapy arms of the BIG 1–98 clinical trial who did not have either vasomotor or arthralgia/myalgia/carpal tunnel (AMC) symptoms reported at baseline, started protocol treatment and were alive and disease-free at the 3-month landmark (n=4798) and at the 12-month landmark (n=4682) were used for this report. Cohorts of patients with vasomotor symptoms, AMC symptoms, neither, or both were defined at both 3 and 12 months from randomization. Landmark analyses were performed using Kaplan-Meier method for disease-free survival (DFS) and competing risk methodology for breast cancer free interval (BCFI). Median follow-up was 7.0 years.
Results
Reporting of AMC symptoms was associated with better outcome for both the 3- and 12-month landmark analyses (e.g. 12-month landmark, HR (95% CI) for DFS=0.65 (0.49–0.87), and for BCFI=0.70 (0.49–0.99)). By contrast, reporting of vasomotor symptoms was less clearly associated with DFS (12-month DFS HR (95% CI)=0.82 (0.70–0.96)) and BCFI (12-month DFS HR (95% CI)=0.97 (0.80–1.18). Interaction tests indicated no effect of treatment group on associations between symptoms and outcomes.
Conclusions
While reporting of AMC symptoms was clearly associated with better DFS and BCFI, the association between vasomotor symptoms and outcome was less clear, especially with respect to breast cancer-related events.
3, breast conservation therapy for carcinoma of the breast (6), larynx preservation (7), CMT for carcinoma of the esophagus (8), and both small and non-small cell carcinoma of the lung (9-11). Other examples could undoubtedly be cited as well. Given the unique radiosensitivity of malignant lymphomas, the reluctance of many medical oncologists to embrace the use of CMT for these diseases is curious.Many scholarly publications have detailed the biolo'gical rationale for combinations of chemotherapy and radiation (as well as surgery) (12,13). We will not review them further here. We would like to add, however, four somewhat philosophical musings about oncologists' behavior that might loosely fall under the rubric of principles of CMT:
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