How Does the Interval Between Completion of Adjuvant Chemotherapy and Initiation of Radiotherapy Impact Clinical Outcome
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ORIGINAL ARTICLE – BREAST ONCOLOGY
How Does the Interval Between Completion of Adjuvant Chemotherapy and Initiation of Radiotherapy Impact Clinical Outcomes in Operable Breast Cancer Patients? Lu Cao, MD1, Cheng Xu, MD1, Gang Cai, MD1, Wei-Xiang Qi, MD1, Rong Cai, MD1, Shu-Bei Wang, MD1, Dan Ou, MD1, Min Li, MD1, Kun-Wei Shen, MD2, and Jia-Yi Chen, MD1 1 2
Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
ABSTRACT Purpose. The aim of this study was to evaluate the impact of time to radiotherapy (TTR) after completion of chemotherapy (CT), and TTR after surgery, in breast cancer (BC) patients. Patients and Methods. Continuous breast cancer patients treated with surgery and CT followed by radiotherapy (RT) from 2009 through 2015 were retrospectively reviewed. Patients were categorized into four groups with respect to TTR after CT, i.e.\4, 4–8, 8–12, and[12 weeks, and TTR after surgery, i.e.\147, 147–180, 180–202, and[202 days. The Cox proportional hazards model was used to identify the independent effect of TTRs. Results. Overall, 989 patients were enrolled. Patients with a TTR of [12 weeks after CT showed significantly worse breast cancer-specific survival (BCSS) and overall survival (OS) compared with those who had a TTR of \4 weeks (BCSS: hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.1–0.76; OS: HR 0.33, 95% CI 0.13–0.88), 4–8 weeks (BCSS: HR 0.23, 95% CI 0.08–0.66; OS: HR 0.29, 95% CI 0.11–0.8), and 8–12 weeks (BCSS: HR 0.22, 95% CI 0.05–0.96; OS: HR 0.23, 95% CI 0.06–0.99). TTR after surgery showed no significant association with survival outcomes in the entire cohort, except in patients with hormone receptor (HR)-positive disease and those receiving mastectomy. In HR-positive tumors, a TTR after CT of
Ó Society of Surgical Oncology 2020 First Received: 27 April 2020 Accepted: 28 July 2020 J.-Y. Chen, MD e-mail: [email protected]
[12 weeks remained an independent predictor for adverse BCSS and OS. Conclusion. Initiation of RT beyond 12 weeks after CT might compromise survival outcomes. Efforts should be made to avoid delaying RT, especially after completion of CT and in patients with HR-positive tumors, positive lymph nodes, and those receiving mastectomy.
The role of adjuvant radiotherapy (RT) in reducing recurrences and improving breast cancer survival has been well established;1,2 however, the optimal time to initiation of RT (TTR) is still unclear, especially when adjuvant chemotherapy (CT) is indicated. Some radiobiological models3 have found an increase in local recurrence of 1–2% per month delay in initiation of RT. With the hypothesis that delaying RT might adversely impact prognosis, most trials regarding adjuvant RT in breast cancer would adopt a predefined maximum acceptable TTR after CT or surgery. In clinical practice, an unscheduled delay in initiation of RT after completion of CT can be ascribe
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