Synchronous chemoradiation – administering radiotherapy during or in between chemotherapy cycles to females with early breast cancer significantly reduces the chances of the cancer returning, researchers from Birmingham, England, explained at the European Multidisciplinary Cancer Congress 2011. They added that this type of therapy has minimal adverse events and does not undermine the patient’s quality of life.

The SEquencing of Chemotherapy and Radiotherapy in Adjuvant Breast cancer (SECRAB) study involved 48 centers throughout the United Kingdom – the presenters explained that it is the largest ever study to look at synchronous chemoradiation.

Dr Indrajit Fernando, a Consultant Clinical Oncologist at University Hospitals Birmingham NHS Foundation Trust and Honorary Senior Lecturer at the University of Birmingham, UK, said:

“The results show that synchronous chemoradiation reduces the risk of local cancer recurrence by 35% in women with early breast cancer. After a follow-up of over eight years, only 41 patients in the synchronous chemoradiation group had suffered a recurrence compared with 63 patients in the sequential chemoradiation group.”

Patients who undergo surgery for breast cancer, are generally administered chemotherapy and radiotherapy – the aim is to destroy any remaining cancerous cells in the breast, underarm area, and chest, so that the chances of cancer recurrence are minimized. The current standard treatment schedule includes chemotherapy followed by radiotherapy – sequential chemoradiation.

Early signs of breast cancer
En Breast cancer illustrations

Dr. Fernando, who was also the study’s lead investigator, said:

“The five-year local recurrence rates were 2.8% and 5.1% in the synchronous and sequential chemoradiation groups, respectively. This difference of 2.3% between treatment groups was statistically significant.

According to the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), one breast cancer death can be avoided for every four local recurrences prevented [2]. Therefore, even a 2.3% reduction in local recurrence rates will have an impact worldwide when we consider that this is a very common cancer.”

Cancer experts are forever debating about the best timing for radiotherapy and chemotherapy after breast cancer surgery. Dr. Fernando and team set out to find out what the best schedule might be for administering radiotherapy with CMF (cyclophosphamide/methotrexate/fluorouracil) or anthracycline. They focused on patients with early breast cancer.

This Phase III, randomized study included 2,296 females. 1,011 of them had undergone mastectomy while 1,285 had breast conserving surgery – in both cases to remove a tumor. After their surgical intervention they all received chemoradiation. 1,146 received sequential chemoradiation while 1,150 had synchronous chemoradiation (radiation given in gaps between chemo cycles). Over 60% of them received 40Gy in 15 fractions over a period of three weeks.

Dr. Fernando and team also assessed what skin reactions the women had to radiotherapy, as well as their overall quality of life. Data was gathered from 565 patients to assess quality of life.

Dr. Fernando said:

“Although the results of the main study showed that patients in the synchronous chemoradiation group had a significantly worse skin reaction, only four percent of patients in the synchronous arm had a severe reaction which would have taken several weeks to heal and subsequently affect quality of life. The majority of women had a moderate skin reaction which would have settled in a very short period of time and this had no detrimental effect on their quality of life.

Our data have shown that the acute skin toxicity of radiotherapy treatment was significantly less in patients being treated with three weeks of synchronous radiotherapy (40Gy radiation in 15 fractions) compared to those with schedules of a longer duration (45Gy in 20 fractions over four weeks or 50Gy in 25 fractions over five weeks). Importantly, the clinical benefit of synchronous chemoradiation treatment was seen in both patient groups.”

Dr. Fernando added that their findings may also have economic implications:

“Shortening the overall treatment time may mean that when patients have finished their last chemotherapy course they can return to their normal life without having to then complete their radiotherapy. This may also have economic benefits in terms of when patients can return to work.

Clinical practice needs to be reviewed for patients who are being treated with a CMF or an anthracycline/CMF chemotherapy schedule. The data will be forwarded to the National Institute of Clinical Excellence (NICE) in the UK but the results have implications worldwide.”

Professor Michael Baumann, president of ECCO (European CanCer Organization) said:

“This trial raises the important issue of how radiotherapy and chemotherapy after surgery should be sequenced or integrated to obtain the best outcome in breast cancer. In today’s modern multidisciplinary oncology, not only each single component of treatment needs to be optimised, but also the combination thereof. This requires close interaction of specialists from different specialties in clinical research, as well as in everyday patient care.

The SECRAB trial suggests that the risk of loco-regional recurrences could be reduced by applying radiotherapy simultaneously with chemotherapy. Long term follow-up will still be necessary to assess potential late side-effects and the benefits versus the risks of this approach, but I am convinced that this trial will spur a lot of discussion on optimising adjuvant treatment in this common disease.”

Written by Christian Nordqvist