Optimal timing for adjuvant radiation therapy in breast cancer

Tsoutsou, Pelagia G.; Koukourakis, Michael I.; Azria, D.; Belkacémi, Yazid

doi:10.1016/j.critrevonc.2008.09.002

Cited by 74 publications

(40 citation statements)

References 114 publications

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“…Three review articles indicate an increased risk for local failures with a longer delay than 8 weeks between surgery and radiotherapy (3, 10, 11). These reviews, however, include a variety of different study designs and various breast cancer subtypes.…”

Section: Introductionmentioning

confidence: 99%

Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

Karlsson

Cole

Price

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose The aims of the present study were to update the previous report from two randomized clinical trials, now with median follow-up of 16 years, to analyze the effect of radiotherapy timing on local failure and disease-free survival. Methods and Materials From July 1986 to April 1993 the International Breast Cancer Study Group (IBCSG) Trial VI randomly assigned 1475 pre/perimenopausal women with node-positive breast cancer to receive 3 or 6 cycles of initial chemotherapy (CT). IBCSG Trial VII randomly assigned 1212 postmenopausal women with node-positive breast cancer to receive tamoxifen for 5 years, or tamoxifen for 5 years with three early cycles of initial CT. For patients who received breast-conserving surgery (BCS), radiotherapy (RT) was delayed until initial CT was completed; 4 or 7 months after BCS for Trial VI and 2 or 4 months for Trial VII. We compared RT-timing groups among 433 patients on Trial VI and 285 patients on Trial VII who received BCS plus RT. Endpoints were local failure, regional/distant failure, and disease-free survival (DFS). Results Among pre/perimenopausal patients there were no significant differences in disease-related outcomes. 15-year DFS was 48.2% in the group allocated 3 months initial CT and 44.9% in the group allocated 6 months initial CT (HR=1.12; 95% CI:0.87–1.45). Among postmenopausal patients, 15-year DFS was 46.1% in the no-initial-CT group and 43.3% in the group allocated 3 months initial CT (HR=1.11; 95% CI:0.82–1.51). Corresponding HRs for local failures were 0.94 (95% CI: 0.61–1.46) in Trial VI and 1.51 (95% CI:0.77–2.97) in Trial VII. For regional/distant failures, the respective HRs were 1.15 (95% CI:0.80–1.63) and 1.08 (95% CI:0.69–1.68). Conclusions This study confirms that, after more than 15 years of follow-up, it is reasonable to delay radiotherapy until after the completion of standard chemotherapy.

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Section: Introductionmentioning

confidence: 99%

Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

Karlsson

Cole

Price

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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show abstract

“…Although there is no consistency in the conclusion of each report, the meta-analysis by Huang et al [29] concluded that local recurrence was increased when radiotherapy was delayed by more than 8 weeks after surgery. The review by Tsoutsou et al [30] concluded that the delay in starting radiotherapy reduced the rates of local control and survival, although there was a wide threshold variation from 6 to 20 weeks.…”

Section: Recommendationmentioning

confidence: 98%

The Japanese Breast Cancer Society clinical practice guideline for radiotherapy of breast cancer

et al. 2014

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Clinical questions (CQs) were divided into five sections:(1) Radiotherapy after breast-conserving surgery for stage I-II breast cancer.(2) Radiotherapy after breast-conserving surgery for ductal carcinoma in situ (DCIS). (3) Contraindication for breast-conserving therapy. (4) Post-mastectomy radiotherapy (PMRT) for advanced breast cancer. (5) Radiotherapy for metastasis.Radiotherapy after breast-conserving surgery for stage I-II breast cancer CQ1. Is radiotherapy following breast-conserving surgery recommended for patients with stage I-II breast cancer? RecommendationRadiotherapy should be recommended (Grade A).Although breast-conserving surgery without radiotherapy is performed for some of patients with early-stage breast cancer in Japan, it was found that the rate of local recurrence in the conserved breast was significantly decreased in seven randomized controlled trials (RCTs) from different parts of the world [1-7], a meta-analysis of these clinical trials analyzed by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) [8] with the conclusion that postoperative radiotherapy is essential. The recent meta-analysis of these RCTs confirmed that postoperative radiotherapy significantly improved patient survival rates [8,9].

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“…-une diminution de la FEVG comprise entre 10 Dans dix cas, le trastuzumab a été délivré pendant la radiothérapie, un article de Tsoutsou [18] indique que le schéma hebdomadaire serait moins cardiotoxique que le schéma J1-J21.…”

Section: Dysfonctionnements Cardiaques Relevés Dans L'étudeunclassified

Étude de phase IV de pharmacovigilance portant sur la toxicité cardiaque du trastuzumab en néoadjuvant et adjuvant dans le cancer du sein. Analyse conduite par l’Observatoire des Médicaments et des Innovations Thérapeutiques de Bretagne et des Pays de la Loire (OMIT B PL)

Grude¹,

Campone²,

Lortholary³

et al. 2010

Oncologie

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Optimal timing for adjuvant radiation therapy in breast cancer

Cited by 74 publications

References 114 publications

Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

The Japanese Breast Cancer Society clinical practice guideline for radiotherapy of breast cancer

Étude de phase IV de pharmacovigilance portant sur la toxicité cardiaque du trastuzumab en néoadjuvant et adjuvant dans le cancer du sein. Analyse conduite par l’Observatoire des Médicaments et des Innovations Thérapeutiques de Bretagne et des Pays de la Loire (OMIT B PL)

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