title: Does timing of adjuvant chemotherapy for early breast cancer influence survival?
abstract: OBJECTIVE
  Theoretically, patients with early breast cancer might benefit from starting adjuvant chemotherapy soon after surgery, and this would have important clinical implications. We have addressed this question from a large, single-center database in which the majority of patients received anthracyclines.
  
  
  METHODS
  A total of 1161 patients from a prospectively maintained database treated with adjuvant chemotherapy for early breast cancer at the Royal Marsden Hospital (London, United Kingdom), including 686 (59%) receiving anthracyclines, were retrospectively analyzed. The disease-free survival (DFS) and overall survival (OS) of the 368 patients starting chemotherapy within 21 days of surgery (group A) were compared with those of the 793 patients commencing chemotherapy >or= 21 days after surgery (group B). Median follow-up time was 39 months (range, 12 to 147 months).
  
  
  RESULTS
  No significant difference in 5-year DFS was found between the two groups overall (70% for group A v 72% for group B; P =.4) or in any subgroup. Likewise, there was no difference in 5-year OS (82% for group A v 84% for group B; P =.2) or when the interval to the start of chemotherapy was considered as a continuous variable (P =.4).
  
  
  CONCLUSIONS
  We have been unable to identify any significant survival benefit from starting adjuvant chemotherapy early after surgery, either overall or in any subset of patients.
authors.affiliation: Breast Unity, Royal Marsden Hospital, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Shannon
authors.forename: S
authors.initials: S
authors.lastname: Ashley
authors.forename: I E
authors.initials: IE
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors