Hickey Brigid E, Francis Daniel P, Lehman Margot
Radiation Oncology Mater Service, Princess Alexandra Hospital, Brisbane, Australia.
Cochrane Database Syst Rev. 2013 Apr 30(4):CD005212. doi: 10.1002/14651858.CD005212.pub3.
After surgery for localised breast cancer, radiotherapy (RT) improves both local control and breast cancer-specific survival. In patients at risk of harbouring micro-metastatic disease, adjuvant chemotherapy (CT) improves 15-year survival. However, the best sequence of administering these two types of adjuvant therapy for early-stage breast cancer is unclear.
To determine the effects of different sequencing of adjuvant CT and RT for women with early breast cancer.
An updated search was carried out in the Cochrane Breast Cancer Group's Specialised Register (20 May 2011), MEDLINE (14 December 2011), EMBASE (20 May 2011) and World Health Organization (WHO) International Clinical Trials Registry Platform (20 May 2011). Details of the search strategy and methods of coding for the Specialised Register are described in the Group's module in The Cochrane Library. We extracted studies that had been coded as 'early', 'chemotherapy' and 'radiotherapy'.
We included randomised controlled trials evaluating different sequencing of CT and RT.
We assessed the eligibility and quality of the identified studies and extracted data from the published reports of the included trials. We derived odds ratios (OR) and hazard ratios (HR) from the available numerical data. Toxicity data were extracted, where reported. We used a fixed-effect model for meta-analysis and conducted analyses on the basis of the method of sequencing of the two treatments.
Three trials reporting two different sequencing comparisons were identified. There were no significant differences between the various methods of sequencing adjuvant therapy for local recurrence-free survival, overall survival, relapse-free survival and metastasis-free survival based on 1166 randomised women in three trials. Concurrent chemoradiation increased anaemia (OR 1.54; 95% confidence interval (CI) 1.10 to 2.15), telangiectasia (OR 3.85; 95% CI 1.37 to 10.87) and pigmentation (OR 15.96; 95% CI 2.06 to 123.68). Treated women did not report worse cosmesis with concurrent chemoradiation but physician-reported assessments did (OR 1.14; 95% CI 0.42 to 3.07). Other measures of toxicity did not differ between the two types of sequencing. On the basis of one trial (244 women), RT before CT was associated with an increased risk of neutropenic sepsis (OR 2.96; 95% CI 1.26 to 6.98) compared with CT before RT, but other measures of toxicity did not differ.
AUTHORS' CONCLUSIONS: The data included in this review, from three well-conducted randomised trials, suggest that different methods of sequencing CT and RT do not appear to have a major effect on recurrence or survival for women with breast cancer if RT is commenced within seven months after surgery.
局部乳腺癌手术后，放疗（RT）可改善局部控制率和乳腺癌特异性生存率。对于有微转移疾病风险的患者，辅助化疗（CT）可提高15年生存率。然而，这两种辅助治疗早期乳腺癌的最佳顺序尚不清楚。
确定辅助性CT和RT不同顺序对早期乳腺癌女性的影响。
在Cochrane乳腺癌小组专业注册库（2011年5月20日）、MEDLINE（2011年12月14日）、EMBASE（2011年5月20日）和世界卫生组织（WHO）国际临床试验注册平台（2011年5月20日）进行了更新检索。检索策略的详细信息和专业注册库的编码方法在Cochrane图书馆的小组模块中有描述。我们提取了编码为“早期”“化疗”和“放疗”的研究。
我们纳入了评估CT和RT不同顺序的随机对照试验。
我们评估了所确定研究的合格性和质量，并从纳入试验的已发表报告中提取数据。我们从可用的数值数据中得出比值比（OR）和风险比（HR）。如有报道，提取毒性数据。我们使用固定效应模型进行荟萃分析，并根据两种治疗的测序方法进行分析。
确定了三项报告两种不同测序比较的试验。基于三项试验中的1166名随机分组女性，辅助治疗的不同测序方法在无局部复发生存率、总生存率、无复发生存率和无转移生存率方面没有显著差异。同步放化疗增加了贫血（OR 1.54；95%置信区间（CI）1.10至2.15）、毛细血管扩张（OR 3.85；95% CI 1.37至10.87）和色素沉着（OR 15.96；95% CI 2.06至123.68）的发生率。接受治疗的女性未报告同步放化疗的美容效果更差，但医生报告的评估显示有差异（OR 1.14；95% CI 0.42至3.07）。两种测序类型之间的其他毒性指标没有差异。基于一项试验（244名女性），与放疗前化疗相比，化疗前放疗与中性粒细胞减少性败血症风险增加相关（OR 2.96；95% CI 1.26至6.98），但其他毒性指标没有差异。
本综述纳入的数据来自三项实施良好的随机试验，表明如果在手术后七个月内开始放疗，CT和RT的不同测序方法似乎对乳腺癌女性的复发或生存没有重大影响。
