Skip to main content

Optimal timing of adjuvant treatment in patients with early breast cancer

Abstract

It is well established that adjuvant treatment reduces mortality after early breast cancer. However, the optimal timing of adjuvant treatment is not well described. To determine the optimal timing of adjuvant treatment, 402 breast cancer patients who received adjuvant treatment at Ankara Oncology Research and Training Hospital between January 1995 and August 2002 were evaluated retrospectively. Three hundred and fifty-seven (88.8%) patients received adjuvant chemotherapy, 204 (50.7%) of these patients received only adjuvant chemotherapy and 153 (38%) patients received tamoxifen following chemotherapy. Remaining 45 (11.2%) patients received only adjuvant tamoxifen. The median time to start adjuvant treatment after surgery was day 21 (range, days 4 to days 258), and the median follow-up was 50 months (range, 6–105 months). The patients were divided into 5 groups according to starting time of chemotherapy (shorter than 14 days, between days 15–29, between days 30–44, between days 45.−59 and more than 59 days). Overall survival (OS) and disease-free survival (DFS) were not shown significantly different between for 5 groups (P > 0.05). Secondly, patients were divided into two groups as starting adjuvant treatment equal to or shorter than 44 days and longer than 44 days (n = 344, 85.6% and vs. n = 58, 14.4%, respectively). OS was significantly better in patients who started to receive adjuvant treatment within 44 days after surgery compared to patients who received adjuvant treatment after 44 days (92 vs. 83.3%, P = 0.03) for 5 years, but DFS was not significantly different between two groups (83.4 vs. 82.2%, P > 0.05). According to our study, adjuvant treatment of breast cancer should be initiated earlier after surgery.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Haskel CM. Breast cancer: In: Haskell CM, editor. Cancer treatment, 5th edn. Philedelphia PA: W.B. Saunders Company; 2001. pp. 505–595.

  2. Box BA, Russell CA. Breast cancer: manuel of clinical oncology. In: Casciato DA, editor. Fifth Edition. Philadelphia: Lippincott Williams and Wilkins; 2004. pp. 233–253.

  3. Green MC, Hortobagyi GN. Adjuvant chemotherapy for breast cancer. Langenbecks Arch Surg. 2002;387:109–16.

    PubMed  Article  Google Scholar 

  4. Burdette-Radoux S, Muss HB. Optimizing the use of anthracyclines in the adjuvant treatment of early-stage breast cancer. Clin Breast Cancer. 2003;4:264–72.

    PubMed  Article  CAS  Google Scholar 

  5. Smith IE, Dowsett M. Aromatase inhibitors in breast cancer. N Engl J Med. 2003;348:2431–42.

    PubMed  Article  CAS  Google Scholar 

  6. McCulloch P, Choy A, Martin L. Association between tumour angiogenesis and tumour cell shedding into effluent venous blood during breast cancer surgery. Lancet. 1995;18:1334–5.

    Article  Google Scholar 

  7. The Ludwig Breast Cancer Study Group. Combination adjuvant chemotherapy for node-positive breast cancer. Inadequacy of a single perioperative cycle. N Engl J Med. 1988;5:677–83.

    Google Scholar 

  8. Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II Breast Cancer. J Clin Oncol. 1994;12:888–94.

    PubMed  CAS  Google Scholar 

  9. Buzdar AU. Role of anastrozole in adjuvant therapy for postmenopausal patients. Semin Oncol. 2003;30:21–9.

    PubMed  Article  CAS  Google Scholar 

  10. Pestalozzi BC, Luporsi-Gely E, Jost LM, Bergh J. ESMO guidelines task force. ESMO minimum clinical recommendations for diagnosis, adjuvant treatment and follow-up of primary breast cancer. Ann Oncol. 2005;16(Suppl 1):7–9.

    Article  Google Scholar 

  11. Martin C, Cutuli B, Velten M. Predictive model of axillary lymph node involvement in women with small invasive breast carcinoma: axillary metastases in breast carcinoma. Cancer. 2002;94:314–22.

    PubMed  Article  Google Scholar 

  12. Pinto AE, Andre S, Pereira T, et al. C-erbB-2 oncoprotein overexpression identifies a subgroup of estrogen receptor positive (ER +) breast cancer patients with poor prognosis. Ann Oncol. 2001;12:525–33.

    PubMed  Article  CAS  Google Scholar 

  13. Silvestrini R, Benini E, Daidone MG, Veneroni S, Boracchi P, Cappelletti V, Di Fronzo G. Veronesi U: p53 as an independent prognostic marker in lymph node-negative breast cancer patients. J Natl Cancer Inst. 1993;85:965–70.

    PubMed  Article  CAS  Google Scholar 

  14. Shannon C, Ashley S, Smith IE. Does timing of adjuvant chemotherapy for early breast cancer influence survival? J Clin Oncol. 2003;21:3792–7.

    PubMed  Article  CAS  Google Scholar 

  15. Crown J. Adjuvant systemic chemotherapy of patients with node-positive breast cancer. In: Perry MC, editor. Educational book of American Society of Clinical Oncology. Alexandria, VA: American Society of Clinical Oncology;2004. pp. 28–35.

  16. Fisher B, Gunduz N, Coyle J, et al. Presence of a growth-stimulating factor in serum following primary tumor removal in mice. Cancer Res. 1989;49:1996–2001.

    PubMed  CAS  Google Scholar 

  17. Fisher B, Saffer E, Rudock C, et al. Effect of local or systemic treatment prior to primary tumor removal on the production and response to a serum growth-stimulating factor in mice. Cancer Res. 1989;49:2002–4.

    PubMed  CAS  Google Scholar 

  18. Colleoni M, Bonetti M, Coates AS, et al. Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors. The international breast cancer study group. J Clin Oncol. 2000;18:584–90.

    PubMed  CAS  Google Scholar 

  19. Pronzato P, Campora E, Amoroso D, et al. Impact of administration-related factors on outcome of adjuvant chemotherapy for primary breast cancer. Am J Clin Oncol. 1989;12:481–5.

    PubMed  Article  CAS  Google Scholar 

  20. Altundag MK, Celik I, Ozisik Y. Is there a range of time for initiation of adjuvant chemotherapy in patients with malignancy? Ann Oncol. 2000;11:1209.

    PubMed  Article  CAS  Google Scholar 

  21. van der Hage JA, van de Velde CJ, et al. Improved survival after one course of perioperative chemotherapy in early breast cancer patients. Long-term results from the European organization for research and treatment of cancer (EORTC) Trial 10854. Eur J Cancer. 2001;37:2184–93.

    Google Scholar 

  22. Sertoli MR, Bruzzi P, Pronzato P, et al. Randomized cooperative study of perioperative chemotherapy in breast cancer. J Clin Oncol. 1995;13:2712–21.

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kadri Altundag.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Alkis, N., Durnali, A.G., Arslan, U.Y. et al. Optimal timing of adjuvant treatment in patients with early breast cancer. Med Oncol 28, 1255–1259 (2011). https://doi.org/10.1007/s12032-010-9566-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12032-010-9566-4

Keywords

  • Adjuvant treatment
  • Breast cancer
  • Timing