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Concurrent paclitaxel and radiotherapy for node positive breast cancer

Date

10 Oct 2016

Session

Poster display

Presenters

mohamed Kassem

Citation

Annals of Oncology (2016) 27 (6): 43-67. 10.1093/annonc/mdw364

Authors

M.A.R. Kassem1, A.A. Hassan1, N.Y. Ibrahim2, A.A.M. Toeama3

Author affiliations

  • 1 Oncology, Kasr Al-Aini Ctr of Clin Oncology and Nuclear Medicine(NEMROCK), Cairo Univ, 19031 - Cairo/EG
  • 2 Oncology, Faculty Of Medicine Kasr Al Ainy - Cairo University, 19031 - Cairo/EG
  • 3 Oncology, Assuit University, 13425 - Cairo/EG
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Resources

Background

Concurrent chemo-radiotherapy in breast cancer (BC) may yield better local control with minimal toxicity in node positive patients. The feasibility of paclitaxel with radiotherapy was assessed for tolerability, cosmetic outcome as well as local control

Methods

All female BC with stage II-III were included in the study. Adjuvant chemotherapy was 4 cycles AC (Doxorubicin 60mg/m2+ cyclophosphamide 600mg/m2) followed by 4cycles of Paclitaxel 60mg/m2 weekly for 12 weeks concurrent with 3D Conformal radiotherapy in a dose of 45Gy/20ttt/4wks to the whole breast and supraclavicular nodal region. Boost of 10Gy/5ttt was given to the tumor bed in conservative cases. Evaluation of lung function was done by carbon monoxide diffusion. Radiotherapy toxicity and breast cosmesis were assessed by the RTOG and Harvard criteria respectively. The cosmesis was assessed and scored at the beginning & end of RT and every 6 months thereafter. This was done by patient (subjective score) and physician (objective score) by comparing it with the contralateral untreated breast.

Results

There were 40 patients, 50% underwent modified radical mastectomy and the other half had conservative surgery. The mean age was 50 years (31-70). With 24months follow up, the overall survival was 92% with no local relapse or radiation pneumonitis. There was no significant change in carbon monoxide diffusion after radiotherapy (p: 0.55). There was 15% delay in radiotherapy mainly due to acute GIII skin toxicity 7.5% followed equally by mucositis, tender erythema and wound gap. In only one patient, acute cosmesis and grade III skin toxicity was related to the volume of irradiated breast tissue. At the last follow up, the majority of patients declared excellent score in 62.5%, good in 20%, fair in 10% and poor in 7.5%. Subjective patient's satisfaction for the shape, color &size of the treated breast was 93%.

Conclusions

In conclusion, concurrent chemo-radiotherapy with weekly paclitaxel minimized the treatment duration with acceptable tolerance, cosmesis and good local control

Clinical trial identification

Legal entity responsible for the study

Kasr Alainy Center of Oncology and Nuclear Medicine

Funding

Kasr Alainy Center of Oncology and Nuclear Medicine

Disclosure

All authors have declared no conflicts of interest.

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