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[Sequential study of radiotherapy and hormonal therapy in breast cancer patients undergoing mastectomy or
Xi-Cheng Wang1, Xiao-Bo Huang, Wei-Dong Zhang
1Department of Oncology, Affiliated hospital of Guangdong Medical College, Guangzhou 510080, China.
Objective:
To investigate the optimal sequence of adjuvant radiotherapy and hormonal therapy in patients with breast cancer.
Methods:
From January 1998 to December 2003, 163 patients with breast cancer at our Cancer Center were eligible for this retrospective study. They underwent mastectomy or conservative surgery and received both adjuvant radiotherapy and hormonal therapy with either tamoxifen (TAM) or aromatase inhibitors (AI). According to whether hormonal therapy was administered sequentially after completion of radiotherapy or concurrently with radiotherapy, the patients were grouped as TAM sequential (TAM-SEQ) (n = 65), TAM concurrent (TAM-CON) (n = 52) and AI sequential (Al-SEQ) (n = 27) and AI concurrent (AI-CON) (n = 21). Treatment complications and prognostic outcomes were followed up and analyzed.
Results:
The median follow-up was 84, 79 months for TAM_SEQ, TAM-CON groups, and 67, 63 months for AI-SEQ, AI-CON groups. The occurrence rate of lung and skin fibrosis were 3.2% vs 7.7% (P = 0.407), 4.8% vs 9.6% (P = 0.464) in the TAM-AEQ and TAM-CON groups, and 7.4% vs 4.8% (P = 0.595), 11.1% vs 9.5% (P = 0.594) in AI-SEQ and AI-CON groups. TAM-CON group was more frequent than TAM-SEQ group in the occurrence of lung and skin fibrosis. The local relapse rate and distant metastasis rate were 28.6% vs 25.0% (P = 0.668), 33.3% vs 32.7% (P = 0.942) in the TAM-AEQ and TAM-CON groups, and 22.2% vs 9.5% (P = 0.437), 25.9% vs 19.0% (P = 0.733) in AI-SEQ and AI-CON groups. Local relapse rate in AI-SEQ group was a little higher. There were no significant difference between either TAM-SEQ and TAM-CON groups or AI-SEQ and AI-CON groups in relapse-free survival and overall survival (P > 0.05). The COX multivariate analysis revealed AI-CON was a favorable independent prognostic factor for relapse-free survival (P = 0.025).
Conclusion:
The sequential or concurrent sequence of adjuvant radiotherapy and hormonal therapy does not affect the local control and survival prognosis significantly, especially with TAM. However, TAM administered concurrently with radiotherapy slightly increases the occurrence rate of lung and skin fibrosis. Concurrent administration of AI and sequential TAM with radiotherapy is preferred in clinical practice. Further prospective randomized trials will be needed to validate these results.
