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Concurrent administration of CMF chemotherapy and radiotherapy after breast-conserving surgery for mammary carcinomas
Several retrospective studies and one
prospective randomized trial showed no statistically significant
differences in first failure patterns and event-free survival between
patients receiving chemotherapy first and those receiving radiotherapy
first as adjuvant treatment after breast-conserving surgery for mammary
carcinomas (1-2). Our study was designed to test a third option,
that is, concurrent radiotherapy and CMF chemotherapy in comparison to the
sequence of CMF chemotherapy followed by radiotherapy. The concurrent
treatment has the potential of increasing local control by reducing the
overall treatment time and by exploiting the interaction between the two
modalities. Naturally, the concurrent treatment could cause an increase in
toxicity and a reduction in patient compliance. Our study (Arcangeli
G et al.: "A Phase III randomized study on the sequencing of
radiotherapy and chemotherapy in the conservative management of
early-stage breast cancer", Int J Radiat Oncol Biol Phys. 2005 Oct
11; [Epub ahead of print])
had that the concurrent
administration of CMF chemotherapy and radiotherapy as adjuvant treatment
provides similar local failure rates and survival and does not increase
local or systemic toxicity in comparison to the sequential schedule of CMF
followed by radiotherapy. However, no patient in this study had high risk
for local recurrence such as infiltration of surgical margins and/or large
tumor size. The findings of this study suggest that in
patients without specific risk for local recurrence, radiotherapy can be
delayed up to 7 months. Conversely, concurrent treatment, with its
potentially increased effectiveness for local control, could perhaps, be
more appropriate to patients with high risk of local recurrence, as showed
by other studies (2-3). These suggestions, however, are strictly
limited to the combination of radiotherapy and CMF chemotherapy and cannot
be employed when other drugs are used. CMF is, presently, rarely used as adjuvant
chemotherapy, since it is often replaced by drug combinations, including
anthracyclines and taxanes, apparently more effective than CMF in
controlling micrometastases. This drugs, however, have the potential of
increasing local toxicity when given concurrently with radiation (4) and
therefore, additional studies, employing the chemotherapy agents more
commonly used today, are necessary to confirm the validity of the
treatment strategy emerged from our study.
References:
Giorgio Arcangeli Regina Elena National Cancer Institute, Rome, Italy
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