Optimal TIming of Radiation Therapy
Over the course of the many years that I have been an oncology social worker, I have observed a range of strategies for adjuvant chemotherapy and radiation. Although the most common plan has always been chemo first, then radiation, there have been a number of studies to consider something different. For example, when I was first diagnosed with breast cancer in 1993, I enrolled in a clinical trial that involved concurrent radiation and chemotherapy. After the six and a half weeks of radiation were completed, the chemotherapy continued for another four months. The question being studied was whether simultaneous chemotherapy would make the radiation even more effective. (Apparently the answer was "no" because that particular sequence did not become the standard of care).
Recently, there has been a increase in the number of women who are treated with neo-adjuvant chemotherapy--meaning that the chemo comes first, then surgery, than radiation. By and large, however, most women have surgery first, then chemo (if needed), then radiation therapy and finally, if appropriate, begin a hormonal treatment.
Thought you might be interested in this study which was just published in Oncology/Hematology and reviews the sequencing trials:
Volume 71, Issue 2, Pages 102-116
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a Medical School, Democritus University of Thrace, Department of Radiotherapy and Oncology, Dragana 68 100, Alexandroupolis, Greece
b Department of Radiation Oncology, CRLC Val d'Aurelle, Paul Lamarque, Inserm EMI 0227, Montpellier F-34298,:
Optimal timing for adjuvant radiation therapy in breast cancer: A comprehensive review and perspectives
Pelagia G. Tsoutsou a1, Michael I. Koukourakis a1, David Azria b1,
Yazid Belkacémi c1
Accepted 1 September 2008. published online 15 October 2008.
The optimal sequence of modalities involved in breast cancer treatment with respect to radiotherapy and the maximum acceptable interval between radiotherapy and surgery need to be determined.
This review attempts a critical reading of the literature.
A delay of radiotherapy more than 8-12 weeks after surgery adversely affects local recurrence. Radiotherapy should be administered within 7 months after surgery, when chemotherapy is administered first.
Several chemotherapy regimens can be safely administered concurrently with radiotherapy. The concurrent use of tamoxifen with chemotherapy should be avoided, but not with radiotherapy. Data is insufficient with regard to concurrent use of aromatase inhibitors with radiotherapy. The use of trastuzumab concomitantly with radiotherapy may enhance toxicities but may also improve its efficacy.
Although the issue of radiotherapy delay and that of sequence with chemotherapy or tamoxifen are clarified, the sequence of radiotherapy with aromatase inhibitors and trastuzumab needs to be defined.
Individual radiosensitivity may influence toxicity. New biologic markers have to be determined in the future for tailoring radiotherapy in breast cancer.