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ABSTRACT: Delay in adjuvant radiation treatment and outcomes of
breast cancer a review
Recent meta-analyses have shown the importance of locoregional
control as a long-term determinant of breast cancer survival.
Whether factors related to the delivery of radiotherapy, such as
delay, dose, fractionation or irradiated volume, are associated
with outcome remains unclear.
We performed a critical review of the
literature on delay to radiation using a computerized search of
papers published between 1985 and 2000.
Periods of accrual, details
of radiotherapy, surgical and systemic treatment, and information
on prognostic factors were noted.
Studies on sequencing of adjuvant
therapy were compared to studies on delay to radiation, classified
according to whether or not patients also received chemotherapy.
Comparisons of patients receiving systemic therapy to individuals
spared this option were considered uninformative since the impact
of delaying radiation is then highly confounded by systemic treatment
received.
The single published experimental study on sequencing
suggests that delay to radiation may compromise local control, and
this is consistent with a few retrospective reports on delay to
radiotherapy among patients receiving chemotherapy.
However, indirect
evidence from two randomized clinical trials of chemotherapy, and the
majority of observational studies on delay to radiotherapy, suggest
that it has no impact on either local, distant control or survival.
Factors, methodological, and others, that could explain these
inconsistencies are discussed.
No study restricted to patients at
low risk of recurrence suggested an impact of delaying radiation.
Short chemotherapy regimens are likely to represent a safe option
with respect to outcome of radiation treatment.
[06/27/2002; Breast Cancer Research and Treatment]
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