Effect of Time Interval between Breast-Conserving Surgery and Radiation Therapy on Outcomes of Node-Positive Breast Cancer Patients Treated with Adjuvant Doxorubicin/Cyclophosphamide Followed by Taxane
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Purpose This study evaluated the effect of surgery-radiotherapy interval (SRI) on outcomes in patients treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) and adjuvant four cycles of doxorubicin/cyclophosphamide (AC) followed by four cycles of taxane. Materials and Methods From 1999 to 2007, 397 eligible patients were diagnosed. The effect of SRI on outcomes was analyzed using a Cox proportional hazards model, and a maximal chi-square method was used to identify optimal cut-off value of SRI for each outcome. Results The median SRI was 6.7 months (range, 5.6 to 10.3 months). A SRI of 7 months was the significant cut-off value for distant metastasis-free survival (DMFS) and disease-free survival (DFS) using a maximal chi-square method. For overall survival, a significant cut-off value was not found. The patients with SRI > 7 months had worse 6-year DMFS and DFS than those with SRI ! 7 months on univariate analysis (DMFS, 81% vs. 91%, p=0.003; DFS, 78% vs. 89%, p=0.002). On multivariate analysis, SRI > 7 months did not affect DMFS and DFS. Conclusion RT delayed for more than 7 months after BCS and adjuvant four cycles of AC followed by four cycles of taxane did not compromise clinical outcomes.
Abstract
Purpose This study evaluated the effect of surgery-radiotherapy interval (SRI) on outcomes in patients treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) and adjuvant four cycles of doxorubicin/cyclophosphamide (AC) followed by four cycles of taxane. Materials and Methods From 1999 to 2007, 397 eligible patients were diagnosed. The effect of SRI on outcomes was analyzed using a Cox proportional hazards model, and a maximal chi-square method was used to identify optimal cut-off value of SRI for each outcome. Results The median SRI was 6.7 months (range, 5.6 to 10.3 months). A SRI of 7 months was the significant cut-off value for distant metastasis-free survival (DMFS) and disease-free survival (DFS) using a maximal chi-square method. For overall survival, a significant cut-off value was not found. The patients with SRI > 7 months had worse 6-year DMFS and DFS than those with SRI ! 7 months on univariate analysis (DMFS, 81% vs. 91%, p=0.003; DFS, 78% vs. 89%, p=0.002). On multivariate analysis, SRI > 7 months did not affect DMFS and DFS. Conclusion RT delayed for more than 7 months after BCS and adjuvant four cycles of AC followed by four cycles of taxane did not compromise clinical outcomes.
참고문헌 (15)
- Henderson IC, "Improved outcomes from adding sequential paclitaxel but not from escalating doxorubicin dose in an adjuvant chemotherapy regimen for patients with nodepositive primary breast cancer", J Clin Oncol, 21, pp.976~983 (2003)
- Mamounas EP, "Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer : results from NSABP B-28", J Clin Oncol, 23, pp.3686~3696 (2005)
- Sartor CI, "Effect of addition of adjuvant paclitaxel on radiotherapy delivery and locoregional control of node-positive breast cancer : cancer and leukemia group B 9344", J Clin Oncol, 23, pp.30~40 (2005)
- Johnson A, "The timing of treatment in breast cancer : gaps and delays in treatment can be harmful", Breast Cancer Res Treat, 60, pp.201~209 (2000)
- Karlsson P, "Timing of radiotherapy and outcome in patients receiving adjuvant endocrine therapy", Int J Radiat Oncol Biol Phys, 80, pp.398~402 (2011)
- Buchholz TA, "Effect of delay in radiation in the combined modality treatment of breast cancer", Int J Radiat Oncol Biol Phys, 26, pp.23~35 (1993)
- Tsoutsou PG, "Optimal timing for adjuvant radiation therapy in breast cancer : a comprehensive review and perspectives", Crit Rev Oncol Hematol, 71, pp.102~116 (2009)
- Ruo Redda MG, "Timing of radiotherapy in breast cancer conserving treatment", Cancer Treat Rev, 28, pp.5~10 (2002)
- Huang J, "Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review", J Clin Oncol, 21, pp.555~563 (2003)
- Hickey BE, "Sequencing of chemotherapy and radiotherapy for early breast cancer", Cochrane Database Syst Rev, 4, pp.005212~ (2013)
- Livi L, "Radiotherapy timing in 4, 820 patients with breast cancer : university of florence experience", Int J Radiat Oncol Biol Phys, 73, pp.365~369 (2009)
- Yock TI, "The effect of delaying radiation therapy for systemic chemotherapy on local-regional control in breast cancer", Breast Cancer Res Treat, 84, pp.161~171 (2004)
- Cefaro GA, "The effect of delaying adjuvant radiation treatment after conservative surgery for early breast cancer", Breast J, 13, pp.575~580 (2007)
- Corradini S, "Timing of radiotherapy following breastconserving surgery : outcome of 1393 patients at a single institution", Strahlenther Onkol, 190, pp.352~357 (2014)
- Downing A, "Waiting times for radiotherapy after breast-conserving surgery and the association with survival : a path analysis", Clin Oncol(R Coll Radiol), 23, pp.442~448 (2011)