Concurrent Chemo and Radiation
This may be a topic that is of particular interest only (or mostly) to me, but I am sharing it with you all. In 1993, when I was diagnosed with my first breast cancer, I was treated in a clinical trial that used concurrent radiation and chemotherapy. The standard of care for adjuvant breast cancer chemotherapy at that time was oral CMF. The schedule was this: Chemotherapy (given in a 28 day cycle with treatment on Days 1 and 8 and Cytoxan pills for 14 days) and Radiation began on the same day. Each proceeded with the usual schedule; radiation was, therefore, completed after about six weeks, and chemotherapy continued for a total of six months.
I remember that the burning from radiation was pretty bad and that the chemotherapy side effects were a bit, not much, more intense during the two cycles that corresponded with radiation. I never knew the overall results of the trial, but, based on this article, I am guessing that a large advantage was not found, and occasional studies continue.
Published in Current Breast Cancer Reports, here is the summary from Andrew Seidman, MD and colleagues at MSKCC:
Treating breast cancer patients concurrently with
chemotherapy and radiation is a potentially attractive
approach. The goal is to develop strategies that
enhance the effects of each modality while minimizing
toxicity. Most data evaluating the role of simultaneous
therapy have been generated from small phase 1 and
2 trials. As few prospective, randomized controlled
trials have been performed in this area, generating
definitive conclusions regarding the efficacy and toxicity
from combined therapy remains difficult. This
article reviews the current literature on the benefi ts
and toxicities of concurrent radiation with cytotoxic
chemotherapy, as well as with novel biologic agents
such as monoclonal antibodies, tyrosine kinase inhibitors,
and heat shock protein antagonists. Because the
appropriate use of concurrent radiation with chemotherapy
and biologic agents continues to evolve, we
also highlight future and ongoing trials evaluating this treatment option.