Sequence of radiotherapy and chemotherapy in breast cancer after breast-conserving surgery.
OBJECTIVE
The optimal sequence of radiotherapy and chemotherapy in breast-conserving therapy is unknown.


METHODS
From 1983 through 2007, a total of 641 patients with 653 instances of breast-conserving therapy (BCT), received both chemotherapy and radiotherapy and are the basis of this analysis. Patients were divided into three groups. Groups A and B comprised patients treated before 2005, Group A radiotherapy first and Group B chemotherapy first. Group C consisted of patients treated from 2005 onward, when we had a fixed sequence of radiotherapy first, followed by chemotherapy.


RESULTS
Local control did not show any differences among the three groups. For distant metastasis, no difference was shown between Groups A and B. Group C, when compared with Group A, showed, on univariate and multivariate analyses, a significantly better distant metastasis-free survival. The same was noted for disease-free survival. With respect to disease-specific survival, no differences were shown on multivariate analysis among the three groups.


CONCLUSIONS
Radiotherapy, as an integral part of the primary treatment of BCT, should be administered first, followed by adjuvant chemotherapy.
Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, the Netherlands. J.Jobsen@mst.nl
Jan J
JJ
Jobsen
Job
J
van der Palen
Mariël
M
Brinkhuis
Francisca
F
Ong
Henk
H
Struikmans
D000328:Adult; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D013997:Time Factors
D000970:Antineoplastic Agents