Radiotherapy between or during chemotherapy cycles reduces risk of breast cancer recurrence

A major UK trial has produced firm evidence that giving radiotherapy between or during chemotherapy cycles to women with early breast cancer significantly reduces the risk of the cancer recurring in the breast or chest wall. The treatment, known as synchronous chemoradiation, has minimal adverse side-effects and no detrimental effect on the patients’ quality of life.
Findings from the SEquencing of Chemotherapy and Radiotherapy in Adjuvant Breast cancer (SECRAB) study, which was carried out at 48 centres in the UK and is the largest study to investigate the treatment, will be presented today (Sunday) in Stockholm, to delegates at the 2011 European Multidisciplinary Cancer Congress.
"The results show that synchronous chemoradiation reduces the risk of local cancer recurrence by 35% in women with early breast cancer. After a follow-up of over eight years, only 41 patients in the synchronous chemoradiation group had suffered a recurrence compared with 63 patients in the sequential chemoradiation group," says Dr Indrajit Fernando, a Consultant Clinical Oncologist at University Hospitals Birmingham NHS Foundation Trust and Honorary Senior Lecturer at the University of Birmingham, UK.
Radiotherapy and chemotherapy are usually given after breast cancer surgery to destroy any remaining cancer cells in the breast, chest wall or underarm area, in order to reduce the risk of a local cancer recurrence. Sequential chemoradiation is the standard treatment schedule where chemotherapy is given first followed by radiotherapy.
Dr Fernando, the principal investigator of the study, will say: "The five-year local recurrence rates were 2.8% and 5.1% in the synchronous and sequential chemoradiation groups, respectively. This difference of 2.3% between treatment groups was statistically significant."
He will add: "According to the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), one breast cancer death can be avoided for every four local recurrences prevented. Therefore, even a 2.3% reduction in local recurrence rates will have an impact worldwide when we consider that this is a very common cancer."
The optimal timing of radiotherapy with chemotherapy has been a subject of debate among cancer experts. The aim of this trial was to determine the best schedule for giving radiotherapy with cyclophosphamide/methotrexate/fluorouracil (CMF) or anthracycline–CMF chemotherapy after surgery to women with early breast cancer.
This randomised Phase III trial enrolled 2,296 women who had undergone breast conserving surgery (1,285 women) or mastectomy (1,011 women) to remove their tumour. All the patients received chemoradiation after surgery, either sequential (1,146 patients) or synchronous, where the radiotherapy was given in the gaps between chemotherapy cycles (1,150 patients). More than 60% of patients received 40Gy in 15 fractions over three weeks.