Combination Therapy Shows Improvement for Breast Cancer Patients

Giving radiation therapy and chemotherapy at the same time after a lumpectomy helps keep breast cancer from returning locally, according to a study published in the Dec. 1 issue of the International Journal of Radiation Oncology, Biology and Physics, the official journal of the American Society for Therapeutic Radiology and Oncology Inc. (ASTRO).

Breast cancer widely affects women in the United States, with more than 213,000 women estimated to be diagnosed in 2006. For early-stage breast cancer, the standard treatment is a lumpectomy (surgical removal of the tumor) followed by radiation therapy to the entire breast. Doctors usually recommend chemotherapy in addition for women with invasive disease. When to give the chemotherapy -- whether after surgery, but before radiation or after surgery and radiation -- has been widely debated among researchers.

Cancer researchers at Yale New Haven Hospital in New Haven, Conn., and the Cancer Institute of New Jersey, New Brunswick, N.J., wanted to try to answer the question as to the proper sequencing of chemotherapy. Doctors recorded data from more than 2,000 patients over the course of nearly 25 years. Of those women, 535 patients were treated with the different sequencing of chemotherapy and radiation therapy. Patients were then grouped by how they received the treatment, 276 women received chemotherapy before radiation therapy, 106 women received radiation therapy before chemotherapy, 109 women received concurrent chemotherapy and radiation, and 44 women received the "sandwich" technique of alternating chemotherapy with radiation therapy and then repeating chemotherapy.

The outcome for the women in the study was successful across the group, with 10-year overall survival at 78 percent. Doctors found that there was no significant difference in the way these combinations affected the general patient outcome, but there was a difference in where tumors could relapse. Of the 109 patients who received chemotherapy and radiation therapy at the same time, only 8 percent relapsed locally (in the conservatively treated breast) over 10 years.

Of the women who received radiation therapy before chemotherapy, 13 percent had a local relapse while 22 percent of the women who had chemotherapy before radiation had a local relapse.

"It is important for doctors to test and retest combinations of treatments and how we deliver them to our patients. In this retrospective analysis, by concurrently administering chemotherapy and radiation therapy, there appears to be a benefit to selected patients in terms of local control of the breast cancer. The challenge over the next few years is to identify those patients who would best benefit from this strategy. This can best be accomplished by prospective clinical trials," says Bruce Haffty, M.D., lead author of the study and a radiation oncologist at Robert Johnson Wood Medical School-UMDNJ and the Cancer Institute of New Jersey, in New Brunswick, N.J.