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Concurrent Neoadjuvant Chemotherapy and Radiation Therapy in Locally Advanced Breast Cancer.
Muriel Brackstone1, David Palma2, Alan B Tuck3
1Department of Oncology, London Regional Cancer Program, London, Ontario, Canada; Department of Surgery, London Health Sciences Centre, London, Ontario, Canada.
International Journal of Radiation Oncology, Biology, Physics
|September 6, 2017
Summary
Adding concurrent radiation to neoadjuvant chemotherapy significantly improved pathologic complete response (pCR) in locally advanced breast cancer (LABC). Further trials are needed to optimize toxicity and survival outcomes.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Oncology
Background:
- Locally advanced breast cancer (LABC) requires effective neoadjuvant treatment strategies.
- Standard chemotherapy regimens aim to improve treatment response and survival rates.
- Evaluating the addition of concurrent radiation to neoadjuvant chemotherapy is crucial for optimizing LABC treatment.
Purpose of the Study:
- To assess if concurrent neoadjuvant radiation therapy enhances the pathologic complete response (pCR) in patients with LABC.
- To compare the efficacy of standard chemotherapy versus chemotherapy combined with concurrent radiation.
Main Methods:
- A prospective phase 2 trial involving 32 LABC patients.
- Patients received neoadjuvant chemotherapy (5-FU, epirubicin, cyclophosphamide, docetaxel) with concurrent regional radiation (45 Gy/25 plus 5.4 Gy/5).
- Propensity score matching was used to compare outcomes with a historical control group receiving neoadjuvant chemotherapy and adjuvant radiation.
Main Results:
- Concurrent chemoradiation significantly increased pCR rates (22% vs 14%, P<.001).
- No significant differences were observed in 3-year disease-free survival (81% vs 69%) or overall survival (89% vs 74%).
- Treatment-related toxicities included grade 3 pneumonitis (25%), dermatitis (25%), and one treatment-related death.
Conclusions:
- Concurrent neoadjuvant radiation with radiosensitizing chemotherapy significantly improves pCR in LABC.
- Further randomized trials are recommended to explore taxane-based radiosensitizing chemotherapy to minimize toxicity and confirm survival benefits.
- Optimizing concurrent therapy may offer a better treatment strategy for LABC.
