Reduced dose radiation therapy and concurrent paclitaxel chemotherapy in lymph node-positive breast Cancer: Long-Term Follow-up of a Single-Institution Prospective Study


Advocate Illinois Masonic Creticos Cancer Center


Purpose: Administration of concurrent chemotherapy and radiotherapy (RT) is advantageous as it addresses local disease, potential sites of metastatic disease and delivering both together may provide a synergistic effect resulting in better tumor control. The purpose of this analysis was to report long-term overall survival, disease free survival and local control from our institutional study of post-operative doxorubicin/cyclophosphamide followed by concurrent paclitaxel and reduced dose radiotherapy in patients with node-positive breast cancer.

Methods and materials: 44 women with Stage II or III pathologically confirmed node-positive breast cancer were enrolled in a Phase II, prospective, single-arm trial from June 2000 through December 2004. All patients received breast-conserving surgery and 4 cycles of doxorubicin /cyclophosphamide followed by 4 cycles of paclitaxel delivered every 3 weeks. Radiation was delivered concurrently with the first 2 cycles of paclitaxel. The diffusing capacity for carbon monoxide (DLCO) was measured to evaluate functional lung volume. Pulmonary function tests with DLCO were obtained before and after RT, after completion of chemotherapy, and annually for 5 years.

Results: At a median follow-up of 205 months, overall survival is 75% and progression free survival is 70.5%. There were 2 ipsilateral breast recurrences, both considered new primaries, yielding a local recurrence free survival of 95.5%. The two patients who experienced a local recurrence were successfully salvaged and are disease free. There were no cases of radiation pneumonitis and no significant change in the diffusing capacity for carbon monoxide.

Conclusion: With long-term follow-up, the use of concurrent chemotherapy with low dose radiation as adjuvant treatment for node-positive breast cancer continues to demonstrate excellent disease-free survival, overall survival and local control with acceptable toxicity.

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