Up-front Hypofractionated Radiotherapy Before Third-Generation Chemotherapy in Node-positive Breast Cancer: A...

Area of Science:

• Oncology
• Radiotherapy
• Breast Cancer Treatment

Background:

• Node-positive breast cancer requires adjuvant treatment.
• Standard sequencing involves adjuvant chemotherapy before adjuvant hypofractionated radiotherapy.
• Optimizing treatment timelines is crucial for patient management.

Purpose of the Study:

• To evaluate the time advantages of delivering adjuvant hypofractionated radiotherapy (AH-RT) before third-generation adjuvant chemotherapy (A-CT).
• To compare the standard sequence (A-CT before AH-RT) with the reversed sequence in node-positive breast cancer.
• To assess treatment delays and overall treatment duration.

Main Methods:

• Retrospective analysis of 45 node-positive breast cancer patients (EXP group) treated with AH-RT before A-CT.
• Matched control group (CTRL) of 45 patients treated with standard A-CT before AH-RT.
• Propensity score matching, univariate and multivariate Cox-proportional hazards models, and Pearson's covariance test were used.

Main Results:

• The EXP group showed a significant reduction in time to AH-RT initiation and overall adjuvant treatment time (35 weeks vs. 42 weeks, p=0.032).
• Hematological toxicity caused RT delays in the CTRL group (p=0.022).
• Acute skin toxicity was associated with RT delay and interruption in the CTRL group (p=0.033).

Conclusions:

• Adjuvant hypofractionated radiotherapy before third-generation adjuvant chemotherapy is safe in node-positive breast cancer.
• This reversed sequence offers a significant advantage in shortening the time from surgery to AH-RT initiation.
• The overall adjuvant treatment time is also reduced, improving treatment efficiency.