Faul C, Brufsky A, Gerszten K, Flickinger J, Kunschner A, Jacob H, Vogel V
Department of Radiation Oncology, Division of Haematology/Oncology, University of Pittsburgh, PA, USA.
Eur J Cancer. 2003 Apr;39(6):763-8. doi: 10.1016/s0959-8049(02)00834-1.
With the increasing use of breast-conserving therapy plus systemic chemotherapy for the treatment of early breast cancer, the optimal sequencing of radiation therapy and chemotherapy remains controversial. Sequencing of therapy may influence not only treatment delivery, but control rates, complications and cosmesis. The aim of this study was to evaluate whether concurrent sequencing of standard doses of CMF (cyclophosphamide, methotrexate and 5-fluorouracil) and adjuvant radiation therapy for early breast cancer impacted on optimum treatment delivery. As both an intravenous (i.v.) 3-week regimen and classic (standard) CMF were utilised in this study, both types of CMF were compared. The effect of sequencing on complications and treatment delays were also assessed. 116 patients treated with CMF chemotherapy and adjuvant tangent breast radiation were studied. 73 patients were treated prospectively with concurrent therapy and were retrospectively compared with a matched group of 40 patients treated with sequential or sandwich therapy. All patients had stage 1 or 2 cancers. There were no planned dose reductions introduced for either treatment modality. Concurrent sequencing had no impact on the ability to deliver optimum radiation or chemotherapy doses. There was no significant difference in acute Radiation Therapy Oncology Group (RTOG) skin reactions or complications between the two groups. Although small, there was a significant delay (1.32 days (0-15 versus 0.36 (0-7)) in the concurrent group (P=0.03) in the delivery of radiation therapy. Sequencing had no significant effect on haematological parameters. 'Standard' CMF had a more profound effect on treatment delivery than i.v. CMF (Radiation delay 2.2 days versus 0.26, P=0.002, % chemotherapy delivered 93% versus 99% P=0.000004). At a mean follow-up of 2.6 years, there was no difference in the cosmetic scores between the two groups. Both local and distant control rates were excellent. This study has shown that standard radiation therapy can be delivered safely concurrently with CMF chemotherapy. Whether this approach may lead to better control rates in the future needs further study.
随着保乳治疗联合全身化疗在早期乳腺癌治疗中的应用日益增加，放疗和化疗的最佳顺序仍存在争议。治疗顺序不仅可能影响治疗的实施，还会影响控制率、并发症和美观效果。本研究的目的是评估早期乳腺癌标准剂量的CMF（环磷酰胺、甲氨蝶呤和5-氟尿嘧啶）与辅助放疗同时进行的顺序是否会影响最佳治疗的实施。由于本研究中使用了静脉注射3周方案和经典（标准）CMF，因此对两种类型的CMF进行了比较。还评估了治疗顺序对并发症和治疗延迟的影响。对116例接受CMF化疗和辅助乳腺切线放疗的患者进行了研究。73例患者接受了前瞻性同步治疗，并与40例接受序贯或夹心治疗的匹配组患者进行了回顾性比较。所有患者均为1期或2期癌症。两种治疗方式均未计划减少剂量。同步顺序对给予最佳放疗或化疗剂量的能力没有影响。两组之间急性放射肿瘤学组（RTOG）皮肤反应或并发症无显著差异。虽然差异较小，但同步组在放疗实施方面有显著延迟（1.32天（0 - 15天）对0.36天（0 - 7天））（P = 0.03）。治疗顺序对血液学参数无显著影响。“标准”CMF对治疗实施的影响比静脉注射CMF更显著（放疗延迟2.2天对0.26天，P = 0.002，化疗给药百分比93%对99%，P = 0.000004）。平均随访2.6年时，两组之间美观评分无差异。局部和远处控制率均良好。本研究表明，标准放疗可与CMF化疗安全地同时进行。这种方法未来是否能带来更好的控制率需要进一步研究。
