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Previous Volume 334:1356-1361 May 23, 1996 Number 21 Next

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ABSTRACT

Background Patients with early-stage breast cancer who are at substantial risk for systemic metastases are increasingly treated with breast-conserving therapy and adjuvant chemotherapy. However, the optimal sequencing of chemotherapy and radiation therapy is not clear.

Methods Two hundred forty-four patients with stage I or II breast cancer who were at substantial risk for distant metastases were randomly assigned to receive a 12-week course of chemotherapy either before or after radiation therapy. All had had breast-conserving surgery. The median length of follow-up in surviving patients was 58 months (range, 10 to 124).

Results The five-year actuarial rates of cancer recurrence at any site and of distant metastases in the radiotherapy-first group and the chemotherapy-first group were 38 percent and 31 percent (P = 0.17) and 36 percent and 25 percent (P = 0.05), respectively. Overall survival was 73 percent and 81 percent (P = 0.11), respectively. The five-year crude rates of first recurrence according to site in the radiotherapy-first and chemotherapy-first groups, respectively, were 5 percent and 14 percent for local recurrence and 32 percent and 20 percent for distant or regional recurrence or both. This difference in the pattern of recurrence was of borderline statistical significance (P = 0.07).

Conclusions This study suggests that for patients at substantial risk for systemic metastases, it is preferable to give a 12-week course of chemotherapy followed by radiation therapy, rather than radiation therapy followed by chemotherapy.

Source Information

From the Joint Center for Radiation Therapy (A.R., R.S.G., B.S., J.R.H.); the Departments of Radiation Oncology (A.R., J.R.H.) and Medicine (S.E.C.), Beth Israel Hospital and Harvard Medical School; the Breast Evaluation Center, Dana–Farber Cancer Institute (A.R., I.C.H., D.F.H., J.R.H.); the Department of Medicine, Harvard Medical School (I.C.H., D.F.H.); the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (L.N.S.); and the Department of Biostatistics, Dana–Farber Cancer Institute and Harvard School of Public Health (R.S.G.) — all in Boston. Presented in part at the 37th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Miami, October 8–11, 1995.

Address reprint requests to Dr. Come at the Department of Medicine, Beth Israel Hospital, 330 Brookline Ave., Boston, MA 02215.

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