Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer

Abstract

The purpose of the present paper was to evaluate treatment outcome after conservative breast surgery or mastectomy followed by simultaneous adjuvant radiotherapy and cyclophosphamide, methotrexate and fluorouracil (CMF) therapy. Two hundred and sixty eight (268) patients were treated at two Australian and two New Zealand centres between 1981 and July 1995. One hundred and sixty-nine patients underwent conservation surgery and 99 had mastectomies. Median follow-up was 53 months. Conventionally fractionated radiation was delivered simultaneously during the first two cycles of CMF, avoiding radiation on the Fridays that the intravenous components of CMF were delivered. In conservatively treated patients, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 34.5 +/- 5.2%, 25.4 +/- 4.5% and 75.5 +/- 4.8%, respectively. Crude incidence of local relapse at 4 years was 6.3% and at regional/distant sites was 26.3%. Highest grades of granulocyte toxicity (< 0.5 x 10(9)/L), moist desquamation, radiation pneumonitis and persistent breast oedema were recorded in 10.7, 8.5, 8.9 and 17.2%, respectively. In patients treated by mastectomy, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 59.7 +/- 7.3%, 56.7 +/- 7.4% and 50.1 +/- 7%. The crude incidence of local relapse at 4 years was 5.6% and at regional/distant sites it was 45.7%. The issue of appropriate timing of adjuvant therapies has become particularly important with the increasing acknowledgement of the value of anthracycline-based regimens. For women in lower risk categories (e.g. 1-3 nodes positive or node negative), CMF may offer a potentially better therapy, particularly where breast-conserving surgical techniques have been used. In such cases CMF allows the simultaneous delivery of radiotherapy with the result of optimum local control, without compromise or regional or systemic relapse rates. Further randomized trials that directly address the optimal integration of the two modalities, such as the one carried out in Boston, are clearly necessary.

Concurrent cyclophosphamide, methotrexate, and 5‐fluorouracil chemotherapy and radiotherapy for breast carcinoma

“…The first site of recurrence was recorded and for patients who had undergone BCS the 4‐year local and regional/distant recurrence rates were 6.3% and 27%, respectively. These results were considered to be comparable to those achieved in trials of anthracycline‐based adjuvant chemotherapy with delayed RT 24. The locoregional recurrence rate for the patients treated with concurrent CMF/RT in our study was 18% at 5 years.…”

“…For this reason, we have reviewed our experience at the Princess Margaret Hospital, where our policy since the 1980s has been to administer RT concurrently with chemotherapy when CMF is selected as adjuvant systemic therapy. Another nonrandomized study of simultaneous adjuvant CMF and RT for early breast carcinoma has been reported by the Trans‐Tasman Radiation Oncology Group (TROG) 23, 24. Between 1981 and 1995, 268 patients from 4 cancer centers participated in the study.…”

A prospective study of concurrent cyclophosphamide/methotrexate/5‐fluorouracil and reduced‐dose radiotherapy in patients with early‐stage breast carcinoma

“…Other groups have also reported the use of concurrent chemotherapy and radiotherapy in patients with early‐stage breast carcinoma. The Trans‐Tasman Radiation Oncology Group24 conducted a prospective trial of 268 patients treated at 4 centers in New Zealand and Australia with concurrent radiotherapy and CMF, including 169 patients who received breast‐conservation therapy. The whole‐breast dose in 166 of these patients was either 44–45 Gy in 22–23 fractions or 50 Gy in 25 fractions.…”

“…Other investigators found somewhat different results, most likely because of differences in the details of both the chemotherapy and radiotherapy. The Trans‐Tasman Radiation Oncology Group24 reported the development of AML in 1 patient undergoing concurrent treatment with radiotherapy and CMF 4 years after treatment. Approximately 9% of patients (14 of 157 patients) developed radiation pneumonitis.…”