title: Concurrent CMF and radiation therapy for early stage breast cancer: results of a pilot study.
abstract: OBJECTIVE
  The optimal sequencing of chemotherapy (CT) and radiotherapy (RT) for patients with early-stage breast cancer treated with breast-conserving therapy is unresolved. Given the concerns arising from delaying either CT or RT, we conducted a pilot study of a concurrent CT-RT regimen in the hope that this would reduce side effects without decreasing efficacy.
  
  
  METHODS
  From 1992-1994, 112 patients with 0-3 positive nodes received 6 monthly cycles of classic oral chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil (5-FU) (CMF). On day 15 of cycle 1, patients started tangential field RT (39.6 Gy in 22 fractions), followed by a 16 Gy boost in 8 fractions. Median follow-up time for surviving patients was 53 months.
  
  
  RESULTS
  Moist desquamation developed during or shortly after RT in 50% of patients, but only 5 patients required treatment breaks. Grade 4 neutropenia during RT occurred in 16 patients, but only 1 required hospitalization. One patient developed Grade 2 radiation pneumonitis. Ninety-three percent of patients received at least 85% of prescribed drug doses. Cosmetic scores of 51 evaluable patients approximately 2 years after the end of chemotherapy were 47% excellent, 43% good, and 10% fair. We have observed 4 local failures and 20 distant failures.
  
  
  CONCLUSIONS
  This concurrent CT-RT scheme had acceptable toxicity and outcome. Further comparison of this approach allowing prompt initiation of both CT and RT to alternative sequences is warranted.
authors.affiliation: Joint Center for Radiation Therapy, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dubey
authors.forename: A
authors.initials: A
authors.lastname: Recht
authors.forename: S E
authors.initials: SE
authors.lastname: Come
authors.forename: R S
authors.initials: RS
authors.lastname: Gelman
authors.forename: B
authors.initials: B
authors.lastname: Silver
authors.forename: J R
authors.initials: JR
authors.lastname: Harris
authors.forename: L N
authors.initials: LN
authors.lastname: Shulman
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011879:Radiotherapy Dosage
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate