Advertisement

La radiologia medica

, Volume 116, Issue 7, pp 1050–1058 | Cite as

Concomitant adjuvant chemo-radiation therapy with anthracyclinebased regimens in breast cancer: a single centre experience

  • L. Livi
  • I. MeattiniEmail author
  • V. Scotti
  • C. Saieva
  • G. Simontacchi
  • L. Marrazzo
  • C. Franzese
  • S. Cassani
  • F. Paiar
  • V. Di Cataldo
  • J. Nori
  • L. Jose Sanchez
  • S. Bianchi
  • L. Cataliotti
  • G. Biti
Breast Radiology / Senologia

Abstract

Purpose

This study was done to evaluate the toxicity related to concurrent radiotherapy and anthracycline (AC)-based chemotherapy in the adjuvant treatment of early breast cancer and to investigate the impact of treatment interruptions and the feasibility of this uncommon therapeutic approach.

Materials and methods

From September 2002 to December 2007, 60 patients were treated at our Centre. The mean age at presentation was 48.5 (range 38–64) years. All patients underwent conservative surgery, and radiotherapy to the entire breast (mean dose 50 Gy; range 46–52 Gy). AC-based regimens consisted of four cycles of AC (doxorubicin plus cyclophosphamide) or four cycles of epirubicin (EPI) followed by four courses of cyclophosphamide, methotrexate and 5-fluorouracil (CMF).

Results

Concomitant treatment caused acute skin G3 toxicity in 8.9% of patients and one case of G4 toxicity (1.7%). Concerning cardiac assessment, six of the 56 evaluable patients (10.7%) developed an asymptomatic decline of left ventricular ejection fraction >10% and <20% of the baseline value. Radiotherapy was temporarily stopped in 21.3% and chemotherapy in 57.1% of patients.

Conclusions

In our experience, concomitant chemotherapy did not emerge as a significant factor in radiotherapy interruption. Moreover, no severe cardiac events were recorded.

Keywords

Early breast cancer Concomitant chemoradiotherapy Anthracyclines Cardiac toxicity Adjuvant radiotherapy 

Radio-chemioterapia concomitante con regimi a base di antracicline nel trattamento adiuvante del carcinoma mammario: esperienza di un singolo centro

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare la tossicità associata al trattamento adiuvante concomitante radio-/chemioterapico, con chemioterapia a base di antracicline, nel carcinoma mammario, nonché analizzare l’impatto della chemioterapia sulle interruzioni del trattamento radiante e pertanto sulla fattibilità di questo non comune approccio terapeutico.

Materiali e metodi

Da settembre 2002 a dicembre 2007, 60 pazienti sono stati trattati presso il nostro Centro. L’età media alla diagnosi è stata di 48,5 anni (range 38–64). Tutti i pazienti sono stati sottoposti a chirurgia mammaria conservativa e radioterapia adiuvante sul corpo mammario (dose media 50 Gy; range 46–52 Gy). I regimi chemioterapici utilizzati a base di antracicline sono stati: quattro cicli di doxorubicina e ciclofosfamide (AC) oppure quattro cicli di epirubicina (EPI) seguiti da quattro cicli di ciclofosfamide, methotrexate e 5-fluoro uracile (CMF).

Risultati

Il trattamento concomitante ha causato tossicità cutanea acuta G3 nell’8,9% dei pazienti e in un solo caso (1,7%) tossicità G4. Per quanto riguarda la tolleranza cardiologica, sei dei 56 pazienti valutabili (10,7%) hanno sviluppato un decremento asintomatico della frazione di eiezione ventricolare sinistra compreso tra il 10% e il 20% (dall’inizio del trattamento). Il trattamento radiante è stato temporaneamente interrotto nel 21,3% dei casi e il trattamento chemioterapico nel 57,1% dei casi.

Conclusioni

Nella nostra esperienza la chemioterapia concomitante alla radioterapia non ha influenzato significativamente le possibili sospensioni per tossicità della radioterapia. In termini di tossicità non si sono inoltre verificati effetti collaterali cardiaci severi.

Parole chiave

Carcinoma mammario iniziale Chemioradioterapia concomitante Antracicline Tossicità cardiaca Radioterapia adiuvante 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References/Bibliografia

  1. 1.
    Early Breast Trialists’ Collaborative Group (1998) Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet 352:930–942CrossRefGoogle Scholar
  2. 2.
    Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232PubMedCrossRefGoogle Scholar
  3. 3.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365:1687–1717CrossRefGoogle Scholar
  4. 4.
    De Laurentis M, Cancello G, D’Agostino D et al (2008) Taxane based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials. J Clin Oncol 26:44–53CrossRefGoogle Scholar
  5. 5.
    Polyzos A, Malamos N, Boukovinas I et al (2010) FEC versus sequential docetaxel followed by epirubicin/cyclophosphamide as adjuvant chemotherapy in women with axillary node-positive early breast cancer: a randomized study of the Hellenic Oncology Research Group (HORG). Cancer Res Treat 119:95–104CrossRefGoogle Scholar
  6. 6.
    Kaplan HG, Malmgren JA, Atwood M (2009) T1N0 triple negative breast cancer: risk of recurrence and adjuvant chemotherapy. Breast J 15:454–460PubMedCrossRefGoogle Scholar
  7. 7.
    Early Breast Cancer Trialists’ Collaborative Group (2000) Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 355:1757–1770CrossRefGoogle Scholar
  8. 8.
    Recht A, Come SE, Gelman RS et al (1991) Integration of conservative surgery, radiotherapy, and chemotherapy for the treatment of early-stage, node-positive breast cancer: sequencing, timing, and outcome. J Clin Oncol 9:1662–1667PubMedGoogle Scholar
  9. 9.
    Hartsell WF, Recine DC, Greim KL et al (1995) Delaying the initiation of intact breast irradiation from patients with lymph node positive breast cancer increases the risk of local recurrence. Cancer 76:2497–2503PubMedCrossRefGoogle Scholar
  10. 10.
    Banerjee TK, Hoehn JL, Greenlaw RH et al (1984) Chemotherapy drug dose alteration due to radiation therapy in an adjuvant situation in breast cancer. Am J Clin Oncol 7:437–442PubMedCrossRefGoogle Scholar
  11. 11.
    Recht A, Come SE, Henderson IC et al (1996) The sequencing of chemotherapy and radiation therapy after conservative surgery for earlystage breast cancer. N Engl J Med 334:1356–1361PubMedCrossRefGoogle Scholar
  12. 12.
    Habibollahi F, Fentiman IS, Chaudary MA et al (1989) Influence of radiotherapy on the dose of adjuvant chemotherapy in early breast cancer. Breast Cancer Res Treat 13:237–241PubMedCrossRefGoogle Scholar
  13. 13.
    Peters WA 3rd, Liu PY, Barrett RJ 2nd et al (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18:1606–1613PubMedGoogle Scholar
  14. 14.
    Cox JD, Setz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346PubMedCrossRefGoogle Scholar
  15. 15.
    Rubin P, Constine LS, Fajardo LF (1995) RTOG Late Effects Working Group, Overview. Late Effects of Normal Tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 31:1041–1042Google Scholar
  16. 16.
    Fehlauer F, Tribius S, Holler U et al (2003) Long-term radiation sequelae after breast-conserving therapy in women with early-stage breast cancer: An observational study using the LENT-SOMA scoring system. Int J Radiat Oncol Biol Phys 55:651–658PubMedCrossRefGoogle Scholar
  17. 17.
    Leonard CE, Wood ME, Zhen B et al (1995) Does administration of chemotherapy before radiotherapy in breast cancer patients treated with conservative surgery negatively impact local control? J Clin Oncol 13:2906–2915PubMedGoogle Scholar
  18. 18.
    Williers H, Wurschmidt F, Janik I et al (1997) Combined breast preserving surgery, chemotherapy and radiotherapy in the treatment of breast carcinoma. Effect of the interval between surgery and the beginning of radiotherapy. Strahlenther Onkol 173:148–154Google Scholar
  19. 19.
    Goldhirsch A, Coates M, Castiglone-Gertsch M et al (1998) Adjuvant chemoendocrine therapy in postmenapausal breast cancer: Cyclophosphamide methotrexate and fluorouracil dose and schedule may make a difference. J Clin Oncol 16:1358–1362PubMedGoogle Scholar
  20. 20.
    Denham JW, Hamilton CS, Christie D et al (1995) Simultaneous adjuvant radiation therapy and chemotherapy in high-risk breast cancer-toxicity and dose modification: A Transtasman Radiation Oncology Group Multi-Institutional study. Int J Radiat Oncol Biol Phys 31:305–313PubMedCrossRefGoogle Scholar
  21. 21.
    Isaac N, Panzarella T, Lau A et al (2002) Concurrent cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy and radiotherapy for breast carcinoma. Cancer 95:696–703PubMedCrossRefGoogle Scholar
  22. 22.
    Toledano A, Azria D, Garaud P et al (2007) Phase III trial of concurrent or sequential adjuvant chemoradiotherapy after conservative surgery for earlystage breast cancer: final results of the ARCOSEIN trial. J Clin Oncol 25:2334CrossRefGoogle Scholar
  23. 23.
    Arcangeli G, Pinnarò P, Rambone R et al (2006) 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 64:161–167PubMedCrossRefGoogle Scholar
  24. 24.
    Faul C, Brufsky A, Gerszten K et al (2003) Concurrent sequencing of fulldose CMF chemotherapy and radiation therapy in early breast cancer has no effect on treatment delivery. Eur J Cancer 39:763–768PubMedCrossRefGoogle Scholar
  25. 25.
    Han S, Kim J, Sohn S et al (2007) Feasibility of concurrent adjuvant chemotherapy and radiotherapy after breast-conserving surgery in early breast cancer. J Surg Oncol 95:45–50PubMedCrossRefGoogle Scholar
  26. 26.
    Fiets WE, van Helvoirt RP, Nortier JW et al (2003) Acute toxicity of concurrent adjuvant radiotherapy and chemotherapy (CMF or AC) in breast cancer patients. a prospective, comparative, non-randomised study. Eur J Cancer 39:1081–1088Google Scholar
  27. 27.
    Ismaili N, Mellas N, Masbah O et al (2009) Concurrent chemoradiotherapy in adjuvant treatment of breast cancer. Radiat Oncol 4:12PubMedCrossRefGoogle Scholar
  28. 28.
    Livi L, Saieva C, Borghesi S et al (2008) Concurrent cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy and radiotherapy for early breast carcinoma. Int J Radiat Oncol Biol Phys 71:705–709PubMedCrossRefGoogle Scholar
  29. 29.
    Bergh J, Jönsson PE, Glimelius B et al (2001) Swedish Council of Technology Assessment in Health Care: A systematic overview of chemotherapy effects in breast cancer. Acta Oncol 40:253–281PubMedCrossRefGoogle Scholar
  30. 30.
    Hamilton A, Hortobagyi G (2005) Chemotherapy: what progress in the last 5 years? J Clin Oncol 23:1760–1775PubMedCrossRefGoogle Scholar
  31. 31.
    Livi L, Scotti V, Saieva C et al (2010) Outcome after conservative surgery and breast irradiation in 5,717 patients with breast cancer: implications for supraclavicular nodal irradiation. Int J Radiat Oncol Biol Phys 76:978–983PubMedCrossRefGoogle Scholar
  32. 32.
    Kyndi M, Overgaard M, Nielsen HM et al (2009) High local recurrence risk is not associated with large survival reduction after postmastectomy radiotherapy in high-risk breast cancer: a subgroup analysis of DBCG 82 b&c. Radiother Oncol 90:74–79PubMedCrossRefGoogle Scholar
  33. 33.
    Magné N, Castadot P, Chargari C et al (2009) Special focus on cardiac toxicity of different sequences of adjuvant doxorubicin/docetaxel/CMF regimens combined with radiotherapy in breast cancer patients. Radiother Oncol 90:116–121PubMedCrossRefGoogle Scholar
  34. 34.
    Ragaz J, Olivotto IA, Spinelli JJ et al (2005) Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst 97:116–126PubMedCrossRefGoogle Scholar
  35. 35.
    Hurkmans CW, Cho BCJ, Damen E et al (2002) Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation. Radiother Oncol 62:163–171PubMedCrossRefGoogle Scholar
  36. 36.
    Korreman SS, Pedersen AN, Josipovic M et al (2006) Cardiac and pulmonary complication probabilities for breast cancer patients after routine end-inspiration gated radiotherapy. Radiother Oncol 80:257–262PubMedCrossRefGoogle Scholar
  37. 37.
    Hojris I, Overgaard M, Christensen JJ et al (1999) Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group. Lancet 354:1425–1430Google Scholar
  38. 38.
    Jagsi R, Griffith KA, Koelling T et al (2007) Rates of myocardial infarction and coronary artery disease and risk factors in patients treated with radiation therapy for early-stage breast cancer. Cancer 109:650–657PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • L. Livi
    • 1
  • I. Meattini
    • 1
    Email author
  • V. Scotti
    • 1
  • C. Saieva
    • 2
  • G. Simontacchi
    • 1
  • L. Marrazzo
    • 3
  • C. Franzese
    • 1
  • S. Cassani
    • 1
  • F. Paiar
    • 1
  • V. Di Cataldo
    • 1
  • J. Nori
    • 4
  • L. Jose Sanchez
    • 5
  • S. Bianchi
    • 6
  • L. Cataliotti
    • 5
  • G. Biti
    • 1
  1. 1.Radiotherapy UnitUniversity of FlorenceFlorenceItaly
  2. 2.Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention CenterScientific Institute of TuscanyFlorenceItaly
  3. 3.Department of Medical PhysicsUniversity of FlorenceFlorenceItaly
  4. 4.Diagnostic Senology UnitUniversity of FlorenceFlorenceItaly
  5. 5.Department of SurgeryUniversity of FlorenceFlorenceItaly
  6. 6.Department of PathologyUniversity of FlorenceFlorenceItaly

Personalised recommendations