title: Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial.
abstract: OBJECTIVE
  The optimal integration of chemotherapy with radiation (RT) for patients with early-stage breast cancer remains uncertain. We present the long-term results of a prospective randomized trial to address this question.
  
  
  METHODS
  Two hundred forty-four patients were randomly assigned after conservative breast surgery to receive 12 weeks of cyclophosphamide, doxorubicin, methotrexate, fluorouracil, and prednisone (CAMFP) before RT (CT-first) or after RT (RT-first). Median follow-up for surviving patients was 135 months.
  
  
  RESULTS
  There were no significant differences between the CT-first and RT-first arms in time to any event, distant metastasis, or death. Sites of first failure were also not significantly different.
  
  
  CONCLUSIONS
  Among breast cancer patients treated with conservative surgery, there is no advantage to giving RT before adjuvant chemotherapy. However, this study does not have enough statistical power to rule out a clinically important survival benefit for either sequence.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. jbellon@lroc.harvard.edu
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
authors.forename: Steven E
authors.initials: SE
authors.lastname: Come
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Gelman
authors.forename: I Craig
authors.initials: IC
authors.lastname: Henderson
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Silver
authors.forename: Jay R
authors.initials: JR
authors.lastname: Harris
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D013997:Time Factors
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate