New Options for Treating Breast Cancer Editha Krueger, MDIt is estimated that over 190,000 patients will be diagnosed with breast cancer in the United States this year. Approximately 40,600 deaths will result from breast cancer, which ranks second only to lung cancer as a cause of cancer deaths in American women.[1] Breast cancer mortality rates declined in the 1990s, likely because of earlier detection and innovations in treatment. Results from recent clinical trials and investigations of new treatments were presented at ASTRO 2001. The updated results from a prospective randomized trial comparing chemotherapy first (CT-first) and radiation therapy first (RT-first) in the management of early-stage breast cancers was presented in a plenary session[2] by J. Bellon, MD, Dana Farber Cancer Institute, Boston, Massachusetts. Prior to this trial, no previous study directly compared sequencing of chemotherapy and radiation in stage I and II breast cancers. In this study, 244 patients were randomized to CT-first or RT-first and were stratified according to the number of nodes, ER status, and menopausal status. The first published report of this trial with median follow-up of 58 months indicated a significantly higher 5-year actuarial rate of distant metastases in the RT-first arm (36%) as compared with that for the CT-first arm (25%).[3] In addition, a borderline increase in local recurrence as a site of first recurrence was observed in the CT-first arm and of distant recurrence in the RT-first arm.However, these results were not observed with longer follow-up. With a median follow-up of 135 months, no statistically significant difference was found between the RT-first and CT-first arms with regard to freedom from any recurrence, distant metastases, or overall survival. In a model examining the pattern of first recurrence, no difference was found between the 2 arms. However, lower risks for local recurrence were seen with low T stage (relative risk [RR], 0.45) and negative margins (RR, 0.41). Also, the risk for local recurrence in the 2 arms differed depending on margin status. In patients with negative margins, CT-first had a lower risk of local recurrence than RT-first. The opposite pattern prevailed in patients with close (1 mm or less), positive, or unknown margins and the difference was statistically significant (P = .01). The local recurrence rates in patients with negative margins were 13% for RT-first and 6% for CT-first. In patients with close margins, the local recurrence rates were 4% for RT-first and 32% for CT-first. Patients with positive margins had high local recurrence rates (20% in each arm) regardless of the type of sequencing. On the basis of this study, the authors recommend CT-first in margin negative patients, re-excision in patients with close margins, and additional surgery in patients with positive margins. This is in accordance with previously published data that also suggest that a delay in radiotherapy does not increase the rate of local recurrences[4] and a delay in chemotherapy does not increase the rate of distant metastases or negatively impact overall survival in the majority of patients. However, optimal sequencing of radiotherapy and chemotherapy in some circumstances may have to be tailored to the specific patient situation. Medscape 12/01 ASTRO 2001 (Am Soc for Therapeutic Radiology & Oncology) Cancer Treatment Reviews, 5/02 Rtx best after anthracycline chemo, NOT concurrent Breast Cancer Research & Treatment, 6/02 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.