Concurrent Neoadjuvant Chemotherapy and Radiation Therapy in Locally Advanced Breast Cancer
| Autor: | Ann F. Chambers, Muriel Brackstone, Francisco Perera, Theodore A. Vandenberg, Donald H. Taves, David D'Souza, David A. Palma, Leslie Scott, Kylea Potvin, Alan B. Tuck, Anat Kornecki, Giulio Muscedere |
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| Rok vydání: | 2017 |
| Předmět: |
Oncology
Radiation-Sensitizing Agents Cancer Research medicine.medical_specialty medicine.medical_treatment Breast Neoplasms Docetaxel Dexamethasone Disease-Free Survival Drug Administration Schedule 030218 nuclear medicine & medical imaging 03 medical and health sciences Mastectomy Modified Radical 0302 clinical medicine Breast cancer Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Propensity Score Prospective cohort study Cyclophosphamide Epirubicin Radiation Taxane business.industry Hazard ratio Chemoradiotherapy Middle Aged medicine.disease Neoadjuvant Therapy Radiation therapy Chemotherapy Adjuvant 030220 oncology & carcinogenesis Female Taxoids Fluorouracil business Mastectomy medicine.drug |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 99:769-776 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2017.06.005 |
| Popis: | Purpose To evaluate whether concurrent neoadjuvant radiation added to standard chemotherapy could increase the pathologic complete response (pCR) to treatment for locally advanced breast cancer (LABC). Methods and Materials This prospective phase 2 trial recruited 32 LABC patients from 2009 to 2011. Patients received neoadjuvant every-3-weekly 5-fluorouracil (500 mg/m 2 ), epirubicin (100 mg/m 2 ), and cyclophosphamide (500 mg/m 2 ) for 3 cycles, followed by weekly docetaxel (35 mg/m 2 ) for 9 cycles. Regional radiation (45 Gy/25 plus 5.4 Gy/5) was delivered concurrently with docetaxel, then modified radical mastectomy. Patients were matched post hoc by a blinded statistician to a concurrent cohort treated with neoadjuvant chemotherapy, modified radical mastectomy, and adjuvant regional radiation. Results Thirty of 32 patients completed treatment. Twenty-seven were successfully matched by propensity score to 81 control patients by age, stage, and molecular subtype. The concurrent chemoradiation produced a significant increase in pCR (14% vs 22%, P P =.186, hazard ratio 0.51; and 74% vs 89%, P =.162, hazard ratio 0.46). Toxicity included 25% of patients with grade 3 pneumonitis and 25% of patients with dermatitis, and 1 death. Conclusions Concurrent neoadjuvant radiation added to radiosensitizing chemotherapy significantly improved pCR. A prospective randomized clinical trial is warranted to exploit the improved response seen with concurrent therapy but using another radio-sensitizing taxane, to better minimize treatment-related toxicity and determine its impact on overall survival. |
| Databáze: | OpenAIRE |
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