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Combination Therapy and Breast Cancer

December 2006 - A new study published in the International Journal of Radiation Oncology*Biology*Physics has found that radiation therapy and chemotherapy administered concurrently after lumpectomy helps prevent local reoccurrence of breast cancer. Researchers estimate that more than 213 000 women in the USA will be diagnosed with breast cancer in 2006. For early-stage disease, standard treatment is a lumpectomy (surgical removal of the tumor) followed by radiation therapy to the breast. In addition, chemotherapy is usually recommended for women with invasive disease. Researchers at Yale New Haven Hospital and the Cancer Institute of New Jersey sought to help clarify whether optimal outcomes are obtained by giving chemotherapy after surgery but before radiation therapy, or after completion of the other two forms of treatment.

The study retrospectively analysed data from more than 2000 women over approximately a 25-year period. Of 535 women treated with different combinations, 276 received chemotherapy before radiation therapy, 106 received radiation therapy before chemotherapy, 109 received chemotherapy and radiation therapy concurrently, and 44 received chemotherapy followed by radiation therapy and repeated chemotherapy.

Researchers found a successful outcome for the group as a whole, with 78 per cent survival at the 10-year point. There was no significant difference in the way different combinations affected the general outcome, but the location of tumor reoccurrence did appear to be affected. Only 8 per cent of 109 patients who received concurrent chemotherapy and radiation therapy suffered local relapse in 10 years. However, 13 per cent of 106 women who received radiation therapy before chemotherapy, and 22 per cent of 276 women who had chemotherapy before radiation had a local relapse.

Lead author Bruce G. Haffty, radiation oncologist at Robert Johnson Wood Medical School-UMDNJ and the Cancer Institute of New Jersey said:

"It is important for doctors to test and retest combinations of treatments and how we deliver them to our patients. In this retrospective analysis, by concurrently administering chemotherapy and radiation therapy, there appears to be a benefit to selected patients in terms of local control of the breast cancer. The challenge over the next few years is to identify those patients who would best benefit from this strategy. This can best be accomplished by prospective clinical trials."

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