title: Prospective evaluation of concurrent paclitaxel and radiation therapy after adjuvant doxorubicin and cyclophosphamide chemotherapy for Stage II or III breast cancer.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of concurrent radiation therapy and paclitaxel-based adjuvant chemotherapy, given either weekly or every 3 weeks, after adjuvant doxorubicin and cyclophosphamide (AC).
  
  
  METHODS
  After definitive breast surgery and AC chemotherapy, 40 patients with operable Stage II or III breast cancer received protocol-based treatment with concurrent paclitaxel and radiation therapy. Paclitaxel was evaluated on 2 schedules, with treatment given either weeklyx12 weeks (60 mg/m2), or every 3 weeksx4 cycles (135-175 mg/m2). Radiation fields and schedules were determined by the patient's surgery and pathology. The tolerability of concurrent therapy was evaluated in cohorts of 8 patients as a phase I study.
  
  
  RESULTS
  Weekly paclitaxel treatment at 60 mg/m2 per week with concurrent radiation led to dose-limiting toxicity in 4 of 16 patients (25%), including 3 who developed pneumonitis (either Grade 2 [1 patient] or Grade 3 [2 patients]) requiring steroids. Efforts to eliminate this toxicity in combination with weekly paclitaxel through treatment scheduling and CT-based radiotherapy simulation were not successful. By contrast, dose-limiting toxicity was not encountered among patients receiving concurrent radiation with paclitaxel given every 3 weeks at 135-175 mg/m2. However, Grade 2 radiation pneumonitis not requiring steroid therapy was seen in 2 of 24 patients (8%) treated in such a fashion. Excessive radiation dermatitis was not observed with either paclitaxel schedule.
  
  
  CONCLUSIONS
  Concurrent treatment with weekly paclitaxel and radiation therapy is not feasible after adjuvant AC chemotherapy for early-stage breast cancer. Concurrent treatment using a less frequent paclitaxel dosing schedule may be possible, but caution is warranted in light of the apparent possibility of pulmonary injury.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham & Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA. hburstein@partners.org
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Burstein
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
authors.forename: Sharon
authors.initials: S
authors.lastname: Galper
authors.forename: Hsiao-Ming
authors.initials: HM
authors.lastname: Lu
authors.forename: Irene
authors.initials: I
authors.lastname: Kuter
authors.forename: Alphonse G
authors.initials: AG
authors.lastname: Taghian
authors.forename: Julia
authors.initials: J
authors.lastname: Wong
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gelman
authors.forename: Craig A
authors.initials: CA
authors.lastname: Bunnell
authors.forename: Leroy M
authors.initials: LM
authors.lastname: Parker
authors.forename: Judy E
authors.initials: JE
authors.lastname: Garber
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Jay R
authors.initials: JR
authors.lastname: Harris
authors.forename: Simon N
authors.initials: SN
authors.lastname: Powell
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017239:Paclitaxel / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D017564:Radiation Pneumonitis / Q000139:chemically induced / Q000209:etiology; D011838:Radiation-Sensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects
chemical_list: D011838:Radiation-Sensitizing Agents; D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel