title: Sequence of radiation therapy and chemotherapy as adjuvant treatment in breast cancer.
abstract: OBJECTIVE
  The aim of the work was to evaluate the prognostic importance of the sequence of radiotherapy (RT) and chemotherapy (CT) as adjuvant treatment in women with breast cancer who were treated with modified radical mastectomy or total mastectomy and their correlation also with other known prognostic factors.
  
  
  METHODS
  In this retrospective study, 200 women with breast cancer were evaluated. The age ranged from 25 to 73 years, with the mean age of 44 years; 125 patients had stage II and 75 had stage III disease. All were subjected to mastectomy. The influence of the following prognostic factors were evaluated: Age, histological grade, nodal status, number of positive nodes, tumor size, estrogen receptor status, menstrual status and as well as the sequence of radiotherapy and chemotherapy on 5-year locoregional disease free survival, 5-year systemic disease-free survival, and 5-year overall survival.
  
  
  RESULTS
  The 5-year locoregional disease free survival was 90.9% for the entire patient population. Nodal status, number of positive nodes and estrogen receptor status were prognostically significant for locoregional recurrence. The 5-year systemic disease-free survival was 67.6% for the whole group. On univariate analysis, the presence of positive axillary nodes, grade III tumor, ER-negative disease and radiotherapy first followed by chemoyherapy, were independent poor risk factors for systemic recurrence. The 5-year overall survival was 71.8%. On univariate analysis, the presence of positive axillary nodes, grade III tumor, ER-negative disease and radiotherapy first followed by chemotherapy, were independent poor risk factors for death from breast cancer
  
  
  CONCLUSIONS
  In patients with breast cancer, a treatment protocol consisting of 6 cycles of CT followed by RT resulted in a better 5-year OS and DFS, and was easier to administer when compared with other treatment protocols. Ideal candidates are those with early-stage, age >35 years, low tumor grade, positive ER, and absence of positive axillary lymph nodes. Longer follow-up will be necessary to assess efficacy and a randomized clinical trial that included a group for simultaneous comparison would be required to produce definitive results.
  
  
  BACKGROUND
  Breast cancer - Prognostic factors - Radiotherapy sequence.
authors.affiliation: The Departments of Clinical Oncology, Faculty of Medicine, Tanta University.
authors.forename: Abd El-Halim M
authors.initials: Ael-H
authors.lastname: Abu-Hamar
authors.forename: Ashraf F
authors.initials: AF
authors.lastname: Barakat
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Elgantiry
authors.forename: Heba H
authors.initials: HH
authors.lastname: Nasef