Synchronizing radiotherapy treatments with chemotherapy cycles for women with early breast cancer significantly reduces the risk of cancer recurring in the breast or chest wall, while not producing additional adverse side effects that affect long-term quality of life, according to a U.K. trial presented at the 2011 European Multidisciplinary Cancer Congress Sept. 23-27 in Stockholm.
The findings were from the SEquencing of Chemotherapy and Radiotherapy in Adjuvant Breast cancer (SECRAB) study, which was carried out at 48 centers in the U.K. and is the largest study to investigate the treatment.
Between July 1998 and March 2004, nearly 2,300 women were randomly assigned to receive either synchronous chemoradiation or sequential radiation, with particular attention paid to local recurrence rates and changes in quality of life.
Sequential chemoradiation, where chemotherapy is given first followed by radiotherapy, is the standard treatment schedule, though the optimal timing of treatments has been the subject of debate among experts.
According to results in the study abstract, synchronous chemoradiation reduced the risk of local cancer recurrence in women with early breast cancer by 35 percent. After a median follow-up of eight years, only 41 patients in the synchronous arm suffered a recurrence compared with 63 patients in the sequential arm. Local recurrence rates at five years were 2.8 percent for the synchronous group and 5.1 percent for the sequential group.
“According to the Early Breast Cancer Trialists’ Collaborative Group, one breast cancer death can be avoided for every four local recurrences prevented,” Indrajit Fernando, BSc, MBBS, consultant clinical oncologist at University Hospitals Birmingham NHS Foundation Trust and honorary senior lecturer at the University of Birmingham, U.K., said in a statement. “Therefore, even a 2.3 percent reduction in local recurrence rates will have an impact worldwide when we consider that this is a very common cancer."
Fernando and colleagues also analyzed the quality of life of patients in the SECRAB study by looking for any differences in long-lasting side effects between the two treatment strategies, which could include skin reactions and symptoms in the breast or arm.
A total of 565 patients contributed to the quality of life analysis, and the results showed there were no observed differences in quality of life between the synchronous and sequential chemoradiation groups.
While synchronous chemoradiation resulted in significantly worse skin reactions in the short term, only 4 percent of patients had reactions that affected quality of life by taking several weeks to heal. The majority of women had moderate reactions that healed in a short period of time, according to Fernando.
Patients received varying lengths of synchronous radiotherapy time, and Fernando noted that acute skin toxicity was significantly less in patients on a three week radiotherapy schedule compared with schedules of longer duration. "Shortening the overall treatment time may mean that when patients have finished their last chemotherapy course they can return to their normal life without having to then complete their radiotherapy,” he said in the statement. “This may also have economic benefits in terms of when patients can return to work."
Fernando said long-term follow-ups are needed to further assess potential quality of life issues, but he believes the study will spur a conversation about optimizing treatment schedules.