Interview
with Neil Love, MD from Breast Cancer Update for Medical Oncologists,
Program 2 2000
Play
Audio Below:
I
think the question that I get asked more often than any other is
the question of when do we give radiotherapy, because in that study
we randomized patients to get radiotherapy after they’d finished
their chemotherapy. So, again, half of them got it at three months
and half of them got it at six months. Now when we did that study
we were concerned about that because A. Recht published – he
was the first author of a study that we did at the Dana Farber and
Joint Center – in which women were randomized to get chemotherapy
first, followed by radiation or radiation first, followed by chemotherapy.
Now, in that study that Recht published, the patients all had breast-conserving
therapy.
And
we found in that study that there was a higher incidence of local
failure if they got chemotherapy first and a higher incidence of
distant failure if they got radiation therapy first. And so, therefore,
when we did this large trial with the Taxol we were worried that
the same thing would happen. So we followed the patients separately
for distant and for local recurrence – see, there were two
separate endpoints which isn’t true for most studies. And there
are a couple hundred local recurrences. About a third of the patients
in this study got lumpectomy and radiation and the other two-thirds
got mastectomy. Patients were allowed to get adjuvant radiotherapy
if they got mastectomy but, again, it had to come after the chemotherapy.
And we find, contrary to our expectations, that the local recurrence
rate is slightly higher among the women who got only four cycles
of CA followed immediately by chemotherapy, than those who had the
delay, got all their chemotherapy and add radiation at six months.
Those differences are statistically significant, but the trend,
thus far at least, has gone in the opposite direction of what we
would have expected. So it gives us some sort of reassurance that
we’re not doing something terrible by waiting and giving the
radiation at the end. And it also causes some concern that if you
were to, you know, break in the middle and give your radiation,
which is kind of a natural thing to want to do, that you might actually
reduce some of the benefit in terms of improved survival and improved
disease-free survival. So my own feeling is that until we have evidence
from a randomized trial that it’s okay to intersperse radiation
in the middle, it should be given at the end.
