Department of Surgery, Ewha Womans University College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Korea.
Sci Rep. 2022 Jun 24;12(1):10729. doi: 10.1038/s41598-022-14873-9.
The optimal sequence of chemotherapy (CT) and radiotherapy (RT) after surgery in breast cancer patients is unclear. There is a lack of literature on RT given between anthracycline and taxane administration. We evaluated the effect of RT sequence on long-term outcome in breast cancer. Two hundred patients who underwent surgery between January 2009 and December 2012 for node-positive breast cancers were evaluated retrospectively. All patients were treated with doxorubicin and cyclophosphamide (AC) followed by taxane. Sandwich RT group that received RT between AC and taxane was compared to the group that received RT after CT. The mean follow-up period was 105.4 months. The locoregional recurrence (LRR) rate was lower in sandwich RT group (P = 0.012) and there was no significant difference in distant metastasis between the two groups. The RT sequence was an important predictor for LRR in multivariable analysis (P = 0.017). For luminal A subtype, disease-free survival (DFS) was better in sandwich RT group than in CT followed by RT group (P = 0.001). The overall survival did not correlated with RT sequence regardless of subtype. Sandwich RT can offer DFS benefit in luminal A subtype breast cancer. A tailored approach of sequencing chemotherapy and radiotherapy would be needed considering the factors that can influence outcome.
在乳腺癌患者中，手术后化疗（CT）和放疗（RT）的最佳顺序尚不清楚。关于蒽环类药物和紫杉烷类药物给药之间给予 RT 的文献也很少。我们评估了 RT 顺序对乳腺癌长期结果的影响。
回顾性评估了 2009 年 1 月至 2012 年 12 月期间因淋巴结阳性乳腺癌接受手术的 200 例患者。所有患者均接受多柔比星和环磷酰胺（AC）治疗，然后接受紫杉烷治疗。接受 AC 和紫杉烷之间 RT 的夹心 RT 组与接受 CT 后 RT 的组进行比较。
中位随访时间为 105.4 个月。夹心 RT 组局部区域复发（LRR）率较低（P = 0.012），两组远处转移无显著差异。多变量分析显示，RT 顺序是 LRR 的重要预测因素（P = 0.017）。
对于 luminal A 亚型，夹心 RT 组无病生存（DFS）优于 CT 后 RT 组（P = 0.001）。无论亚型如何，总生存与 RT 顺序均无关。夹心 RT 可为 luminal A 型乳腺癌提供 DFS 获益。需要考虑可能影响结果的因素，采用化疗和放疗的个体化序贯方法。
