title: Nonrandomized comparison between concomitant and sequential chemoradiotherapy with anthracyclines in breast cancer.
abstract: To evaluate the tolerance of concomitant administration of anthracycline-based chemotherapy (CHT) and 3-dimensional conformal radiotherapy (RT) after breast-conserving surgery.
  
  
  
  Sixty-seven patients, treated with conservative surgery followed by 3-dimensional whole breast RT and concomitant CHT regimens including “Canadian modified” CEF (5-fluorouracil, epirubicin, cyclophosphamide) or AC (doxorubicin, cyclophosphamide) were evaluated for toxicity. They were compared in terms in compliance and acute toxicity with 67 patients irradiated sequentially after having received anthracyclines.
  
  
  
  Acute grade ≥2 skin toxicity was significantly higher in the concomitant group compared to the sequential group, although the incidence of Grade 3 desquamation showed no statistical difference (9% vs. 3%, p = 0.14). Haematological toxicity represented the main cause of treatment discontinuation, reporting higher rate of grade 3-4 leuco-neutropenia in the concomitant group (20.9% vs. 6%, p = 0.01). Mean RT duration was longer in the concomitant group (51 days vs. 45 days) owing to RT breaks. Late toxicity was acceptable. No symptomatic lung and heart events were reported. Radiological lung hyperdensity was detected in 27.7% of the patients in the concomitant group. Post-treatment left ventricular ejection fraction significantly decreased compared with baseline, but cardiac function remained within the normal range, without any difference between left or right-sided RT.
  
  
  
  Although there was more acute grade ≥2 skin toxicity in the concomitant group, the rate of grade 3 dermatitis was lower than expected, suggesting some advantages of 3-D CRT over older techniques. Haematological toxicity exerted a significant impact on both RT and CHT delivery.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Leonardi
authors.forename: Anna
authors.initials: A
authors.lastname: Morra
authors.forename: Luigi
authors.initials: L
authors.lastname: Santoro
authors.forename: Alessandra
authors.initials: A
authors.lastname: Balduzzi
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Ivaldi
authors.forename: Barbara
authors.initials: B
authors.lastname: Vischioni
authors.forename: Annamaria
authors.initials: A
authors.lastname: Ferrari
authors.forename: Cristiana
authors.initials: C
authors.lastname: Fodor
authors.forename: Veronica
authors.initials: V
authors.lastname: Dell'Acqua
authors.forename: Daniela Maria
authors.initials: DM
authors.lastname: Cardinale
authors.forename: Carlo
authors.initials: C
authors.lastname: Cipolla
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Marco
authors.initials: M
authors.lastname: Colleoni
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage* / Q000009:adverse effects; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D059248:Chemoradiotherapy / Q000009:adverse effects; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic