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The role of chemoradiotherapy in patients with unresectable T4 breast tumors

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Abstract

Purpose

Unresectable T4 tumors of the breast are usually treated with systemic therapies, while the role of local therapies remains debatable. This study aims to evaluate the effectiveness of chemoradiotherapy as a part of T4 breast cancer treatment, and to assess the role of local radiotherapies in patients with unresectable T4 breast tumors.

Materials/methods

Between February 1998 and June 2010, 39 unresectable T4 breast tumors were treated with chemoradiotherapy at our institutes. Clinical stages included stage IIIB (n = 15), stage IIIC (n = 3), and stage IV (n = 21). Twenty-one cases had undergone previous systemic therapies, whereas the remaining 18 cases reported no history of previous treatment. Radiation doses of 59–66 Gy (median 60 Gy) were administered to the breast in addition to concurrent chemotherapies. Acute adverse effects were assessed on a weekly basis during treatment to 2 weeks after completion of treatment, and were scored by the Common Terminology Criteria for Adverse Events v3.0. Treatment response was assessed at 1 month after completion of chemoradiotherapy. Statistical analysis of survival was calculated using the Kaplan–Meier method.

Results

Chemoradiotherapy was completed in all cases. Greater than grade 3 hematological toxicities were observed with regard to lymphocytes (33%), platelets (8%), neutrophils (3%), and hemoglobin (3%). Greater than grade 3 nonhematologic toxicities included chemoradiation dermatitis (23%) and pneumonitis (5%). Sixteen T4 tumors (41%) achieved complete response, whereas 23 (59%) achieved partial response. All patients were treated with chemotherapy and/or endocrine therapy following chemoradiotherapy. The median follow-up period was 20 months (range 3–96 months). Nineteen patients died because of progressive breast cancer. Infield recurrence or relapse was observed in 11 cases during the course of treatment, but only 3 cases were symptomatic. The 2-year overall local control rate was 73.6%, and the survival rate was 65.9%.

Conclusion

Chemoradiotherapy represents a viable option for local treatment of unresectable T4 breast tumors.

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References

  1. NCCN Guidelines for Treatment of Cancer by Site, Breast Cancer. http://www.nccn.com/files/cancer-guidelines/breast/index.html#/78/. Accessed 30 Sep 2011.

  2. Bonner JA, Graces YI, Buchsbaum DJ. Interaction of chemotherapy and radiotherapy, chap 4. In: Gunderson LL, Tepper JE, editors. Clinical radiation oncology. 2nd ed. Philadelphia: Churchill Livingstone; 2007. p. 75–98.

    Google Scholar 

  3. Milas L, Cox JD. Principles of combining radiation therapy and chemotherapy, chap 4. In: Cox JD, Ang KK, editors. Radiation oncology: rationale, technique, results. 9th ed. Philadelphia: Mosby; 2009. p. 102–17.

    Google Scholar 

  4. Formenti SC, Volm M. Part III clinical applications, 12 combined modality therapy in locally advancer breast cancer. In: Choy H, editor. Chemoradiation in cancer therapy. Totowa: Humana; 2003. p. 237–51.

    Google Scholar 

  5. Choi S, Thames HD, Buchholz TA. Clinical part, 17 integration of radiation therapy and systemic therapy for breast cancer. In: Brown JM, Mehta MP, Nieder C, editors. Multimodal concepts for integration of cytotoxic drugs and radiation therapy. Heidelberg: Springer; 2006. p. 251–66.

    Chapter  Google Scholar 

  6. Alvarado-Miranda A, Arrieta O, Gamboa-Vignolle C, Saavedra-Perez D, Morales-Barrera R, Bargallo-Rocha E, et al. Concurrent chemo-radiotherapy following neoadjuvant chemotherapy in locally advanced breast cancer. Radiat Oncol. 2009;11(4):24.

    Article  Google Scholar 

  7. Ellis GK, Barlow WE, Gralow JR, Hortobagyi GN, Russell CA, Royce ME, et al. Phase III comparison of standard doxorubicin and cyclophosphamide versus weekly doxorubicin and daily oral cyclophosphamide plus granulocyte colony-stimulating factor as neoadjuvant therapy for inflammatory and locally advanced breast cancer: SWOG 0012. J Clin Oncol. 2011;29:1014–21.

    Article  CAS  PubMed  Google Scholar 

  8. Taguchi T, Masuda N, Nakayama T, Motomura K, Tsukamoto F, Shimazu K, et al. Phase II trial in Japan of sequential administration of weekly paclitaxel followed by FEC as neoadjuvant chemotherapy for locally advanced breast cancer [KBCSG0206 trial: Kinki Breast Cancer Study Group (KBCSG)]. Oncology. 2010;78:302–8.

    Article  CAS  PubMed  Google Scholar 

  9. Schaake-Koning C, van der Linden EH, Hart G, Engelsman E. Adjuvant chemo- and hormonal therapy in locally advanced breast cancer: a randomized clinical study. Int J Radiat Oncol Biol Phys. 1985;11(10):1759–63.

    Article  CAS  PubMed  Google Scholar 

  10. Rubens RD, Bartelink H, Engelsman E, Hayward JL, Rotmensz N, Sylvester R, et al. Locally advanced breast cancer: the contribution of cytotoxic and endocrine treatment to radiotherapy. An EORTC Breast Cancer Co-operative Group Trial (10792). Eur J Cancer Clin Oncol. 1989;25(4):667–78.

    Article  CAS  PubMed  Google Scholar 

  11. Hennequin C, Giocanti N, Favaudon V. Interaction of ionizing radiation with paclitaxel (Taxol) and docetaxel (Taxotere) in Hela and SQ20B cells. Cancer Res. 1996;56:1842–50.

    CAS  PubMed  Google Scholar 

  12. Choy H. Combining taxanes with radiation for solid tumors. Int J Cancer. 2000;9:113–27.

    Article  Google Scholar 

  13. Karasawa K, Katsui K, Seki K, Kohno M, Hanyu N, Nasu S, et al. Radiotherapy with concurrent docetaxel for advanced and recurrent breast cancer. Breast Cancer. 2003;10:268–74.

    Article  PubMed  Google Scholar 

  14. Mason KA, Kishi K, Hunter N, Buchmiller L, Akimoto T, Komaki R, et al. Effect of docetaxel on the therapeutic ratio of fractionated radiotherapy in vivo. Clin Cancer Res. 1999;5:4149–98.

    Google Scholar 

  15. Koukourakis MI, Giatromanolaki A, Schiza S, Kakolyris S, Georgoulias V. Concurrent twice a week docetaxel and radiotherapy: a dose escalation trial with immunological toxicity evaluation. Int J Radiat Oncol Biol Phys. 1999;43:107–14.

    Article  CAS  PubMed  Google Scholar 

  16. Mason K, Staab A, Hunter N, McBride W, Petersen S, Terry N, et al. Enhancement of tumor radioresponse by docetaxel: involvement of immune system. Int J Oncol. 2001;18:599–606.

    CAS  PubMed  Google Scholar 

  17. Sawada N, Ishikawa T, Sekiguchi F, Tanaka Y, Ishitsuka H. X-ray irradiation induces thymidine phosphorylase and enhances the efficacy of capecitabine (Xeloda) in human cancer xenografts. Clin Cancer Res. 1999;5:2948–53.

    CAS  PubMed  Google Scholar 

  18. Hirowatari H, Karasawa K, Izawa H, Ito K, Sasai K, Furuya T, et al. Full dose capecitabine with local radiotherapy is one of the treatment options for inoperable T4 breast cancer. Jpn J Radiol. 2011;29(3):222–5.

    Article  PubMed  Google Scholar 

  19. Gaui MF, Amorim G, Arcuri RA, Pereira G, Moreira D, Djahjah C, et al. A phase II study of second-line neoadjuvant chemotherapy with capecitabine and radiation therapy for anthracycline-resistant locally advanced breast cancer. Am J Clin Oncol. 2007;30:78–81.

    Article  CAS  PubMed  Google Scholar 

  20. Perloff M, Lesnick GJ, Korzun A, Chu F, Holland JF, Thirlwell MP, et al. Combination chemotherapy with mastectomy or radiotherapy for stage III breast carcinoma: a Cancer and Leukemia Group B study. J Clin Oncol. 1988;6(2):261–9.

    CAS  PubMed  Google Scholar 

  21. Low JA, Berman AW, Steinberg SM, Danforth DN, Lippman ME, Swain SM. Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy. J Clin Oncol. 2004;22(20):4067–74.

    Article  CAS  PubMed  Google Scholar 

  22. Lerouge D, Touboul E, Lefranc JP, Genestie C, Moureau-Zabotto L, Blondon J. Combined chemotherapy and preoperative irradiation for locally advanced noninflammatory breast cancer: updated results in a series of 120 patients. Int J Radiat Oncol Biol Phys. 2004;59(4):1062–73.

    Article  PubMed  Google Scholar 

  23. Rouëssé J, de la Lande B, Bertheault-Cvitkovic F, Serin D, Graïc Y, Combe M, Centre René Huguenin Breast Cancer Group, et al. A phase III randomized trial comparing adjuvant concomitant chemoradiotherapy versus standard adjuvant chemotherapy followed by radiotherapy in operable node-positive breast cancer: final results. Int J Radiat Oncol Biol Phys. 2006;64(4):1072–80.

    Article  PubMed  Google Scholar 

  24. Bellon JR, Lindsley KL, Ellis GK, Gralow JR, Livingston RB, Austin Seymour MM. Concurrent radiation therapy and paclitaxel or docetaxel chemotherapy in high-risk breast cancer. Int J Radiat Oncol Biol Phys. 2000;48(2):393–7.

    Article  CAS  PubMed  Google Scholar 

  25. Formenti SC, Volm M, Skinner KA, Spicer D, Cohen D, Perez E, et al. Preoperative twice-weekly paclitaxel with concurrent radiation therapy followed by surgery and postoperative doxorubicin-based chemotherapy in locally advanced breast cancer: a phase I/II trial. J Clin Oncol. 2003;21(5):864–70.

    Article  CAS  PubMed  Google Scholar 

  26. Kao J, Conzen SD, Jaskowiak NT, Song DH, Recant W, Singh R, et al. Concomitant radiation therapy and paclitaxel for unresectable locally advanced breast cancer: results from two consecutive phase I/II trials. Int J Radiat Oncol Biol Phys. 2005;61(4):1045–53.

    Article  CAS  PubMed  Google Scholar 

  27. Koukourakis MI, Manavis J, Simopoulos C, Liberis V, Giatromanolaki A, Sivridis E. Hypofractionated accelerated radiotherapy with cytoprotection combined with trastuzumab, liposomal doxorubicin, and docetaxel in c-erbB-2-positive breast cancer. Am J Clin Oncol. 2005;28(5):495–500.

    Article  CAS  PubMed  Google Scholar 

  28. Genet D, Lejeune C, Bonnier P, Aubard Y, Venat-Bouvet L, Adjadj DJ, et al. Concomitant intensive chemoradiotherapy induction in non-metastatic inflammatory breast cancer: long-term follow-up. Br J Cancer. 2007;97(7):883–7.

    CAS  PubMed  Google Scholar 

  29. Shanta V, Swaminathan R, Rama R, Radhika R. Retrospective analysis of locally advanced noninflammatory breast cancer from Chennai, South India, 1990–1999. Int J Radiat Oncol Biol Phys. 2008;70(1):51–8.

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Kumiko Karasawa, Hisako Hirowatari, Hiromi Izawa, Tomohiko Furuya & Kana Ito

  2. Department of Medical Physics for Advanced Radiotherapy, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Kumiko Karasawa, Tomohiko Furuya, Shuichi Ozawa & Kana Ito

  3. Department of Breast Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Mitsue Saito

  4. Department of Surgery, Tokyo Rinkai Hospital, 1-4-2 Rinkai-cho, Edogawa-ku, Tokyo, 134-0086, Japan

    Takahisa Suzuki

  5. Department of Radiation Oncology, School of Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8111, Japan

    Norio Mitsuhashi

  6. Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba, Chiba, 263-8555, Japan

    Kumiko Karasawa

Authors
  1. Kumiko Karasawa
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  2. Mitsue Saito
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  3. Hisako Hirowatari
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  4. Hiromi Izawa
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  5. Tomohiko Furuya
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  6. Shuichi Ozawa
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  7. Kana Ito
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  8. Takahisa Suzuki
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  9. Norio Mitsuhashi
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Corresponding author

Correspondence to Kumiko Karasawa.

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Karasawa, K., Saito, M., Hirowatari, H. et al. The role of chemoradiotherapy in patients with unresectable T4 breast tumors. Breast Cancer 20, 254–261 (2013). https://doi.org/10.1007/s12282-012-0336-3

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  • DOI: https://doi.org/10.1007/s12282-012-0336-3

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