Concurrent radiochemotherapy in advanced breast cancer

Area of Science:

• Oncology
• Radiation Oncology
• Medical Oncology

Background:

• Advanced breast cancer (Stage 3 and 4) presents challenges for local control and survival.
• Concurrent chemoradiation offers theoretical advantages over sequential treatment modalities.

Purpose of the Study:

• To assess the feasibility of concurrent systemic chemotherapy and local radiation therapy in patients with advanced breast cancer.
• To evaluate acute toxicities and treatment delivery in this combined modality approach.
• To lay the groundwork for a randomized trial comparing concurrent versus sequential chemo-radiation therapy.

Main Methods:

• 16 patients with Stage 3 and 4 breast cancer received CMFP/CMF chemotherapy concurrently with external beam radiation therapy (5000 rad to breast, 4000-4400 rad to nodes).
• Radiation techniques utilized tangential fields for internal mammary node irradiation while minimizing esophagitis.
• Some patients received Iridium-192 interstitial implantation or preoperative radiation followed by modified mastectomy.

Main Results:

• The combined modality treatment was generally feasible, with successful irradiation achieved.
• Acute toxicities included manageable epidermitis and myelosuppression; two patients required hospitalization for fever.
• Most patients received at least 75% of planned chemotherapy doses; some received Adriamycin post-radiation.
• Preoperative radiation allowed for modified mastectomy without significant morbidity in six patients.

Conclusions:

• Concurrent chemoradiation for advanced breast cancer is feasible and can be delivered with acceptable acute toxicity.
• The findings support the initiation of a randomized prospective study to compare concurrent versus sequential chemo-radiation therapy.
• Such a study could determine optimal treatment sequencing for improved local control and disease-free survival in primary breast cancer.