Anthracycline and concurrent radiotherapy as adjuvant treatment of operable breast cancer: a retrospective cohort study in a single institutionReport as inadecuate




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BMC Research Notes

, 3:247

First Online: 04 October 2010Received: 28 April 2010Accepted: 04 October 2010DOI: 10.1186-1756-0500-3-247

Cite this article as: Ismaili, N., Elmajjaoui, S., Lalya, I. et al. BMC Res Notes 2010 3: 247. doi:10.1186-1756-0500-3-247

Abstract

BackgroundConcurrent chemoradiotherapy CCRT after breast surgery was investigated by few authors and remains controversial, because of concerns of toxicity with taxanes-anthracyclines and radiation. This treatment is not standard and is more commonly used for locally advanced breast cancer. The aim of our study was to evaluate the efficacy and safety of the concomitant use of anthracycline with radiotherapy RT.

FindingsFour hundred women having operable breast cancer, treated by adjuvant chemotherapy CT and RT in concomitant way between January 2001 and December 2003, were included in this retrospective cohort study. The study compares 2 adjuvant treatments using CCRT, the first with anthracycline group A and the second with CMF group B. The CT treatment was repeated every 21 days for 6 courses and the total delivered dose of RT was 50 Gy, divided as 2 Gy daily fractions. Locoregional recurrence free LRFS, event free EFS, and overall survivals OS were estimated by the Kaplan-Meier method. The log-rank test was used to compare survival events. Multivariate Cox-regression was used to evaluate the relationship between patient characteristics, treatment and survival.

In the 2 groups A+B n = 400; 249 in group A and 151 in group B, the median follow-up period was 74.5 months. At 5 years, the isolated LRFS was significantly higher in group A compared to group B 98.7% vs 95.3%; hazard ratio HR = 0.258; 95% CI, 0.067 to 0.997; log-rank P = .034. In addition, the use of anthracycline regimens was associated with a higher rate of 5 years EFS 80.4% vs 75.1%; HR = 0.665; 95% CI, 0.455 to 1.016; log-rank P = .057. The 5 years OS was 83.2% and 79.2% in the anthracycline and CMF groups, respectively HR = 0.708; 95% CI, 0.455 to 1.128; log-rank P = .143. Multivariate analysis confirmed the positive effect of anthracycline regimens on LRFS HR = 0.347; 95% CI, 0.114 to 1.053; log-rank P = .062, EFS HR = 0.539; 95% CI, 0.344 to 0.846; P = 0.012, and OS HR = 0.63; 95% CI, 0.401 to 0.991; P = .046. LRFS, EFS and OS were significantly higher in the anthracycline group where the patients n = 288 received more than 1 cycle of concurrent CT P = .038, P = .026 and P = .038, respectively. LRFS and EFS were significantly higher in the anthracycline group within the BCT subgroup P = .049 and P = .04, respectively. There were more hematologic, and more grade 2-3-4 skin toxicity in the anthracycline group.

ConclusionsAfter mastectomy or BCT, the adjuvant treatment based on anthracycline and concurrent RT reduced breast cancer relapse rate, and significantly improved LRFS, EFS and OS in the patients receiving more than 1 cycle of concurrent CT. There were more hematologic and non hematologic toxicities in the anthracycline group.

AbbreviationsRTradiotherapy

CTchemotherapy

WBIwhole-breast-irradiation

CCRTconcurrent chemoradiotherapy

RDradiation dermatitis

PBIpartial breast irradiation

CMFcyclophosphamide 500 mg-m, methotrexate 60 mg-m, and 5-fluorouracil 500 mg-m

EFSevent free survival

OSoverall survival

LRFSlocoregional recurrence free survival

AC60doxorubicin 60 mg-m and cyclophosphamide 600 mg-m

FEC755-fluorouracile 500 mg-m, epirubicin 75 mg-m, and cyclophosphamide 500 mg-m

FAC505-fluorouracile 500 mg-m, doxorubicin 50 mg-m, and cyclophosphamide 500 mg-m

BCTbreast conservative therapy

LVFEleft ventricular fraction ejection

FNC5-fluoro-uracil 500 mg-m2, mitoxantrone 12 mg-m2 and cyclophosphamide 500 mg-m2.

Electronic supplementary materialThe online version of this article doi:10.1186-1756-0500-3-247 contains supplementary material, which is available to authorized users.

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Author: Nabil Ismaili - Sanaa Elmajjaoui - Issam Lalya - Lamia Boulaamane - Rhizlane Belbaraka - Halima Abahssain - Rachi Aassab -

Source: https://link.springer.com/







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