Concurrent Rt Vs Sequential Rt

NSABP B13

  • 325 patients ; Node - ; ER –
  • Arms
    • RT+ chemo ( given concurrently )
    • no-chemo
  • 8-year rate of recurrence in the ipsilateral breast
    • CRT: 2.6%
    • RT: 13.4%

Reluctance to use concurrent RT and an anthracycline.

French phase III trial

  • Concurrent vs Sequential RT + chemo( mitoxantrone and cyclophosphamide)
  • Local control was improved with concurrent administration
  • Concurrent treatment was also associated with an increased incidence of grade 2 or greater late side effects
  • However, an attempt to employ concurrent RT and weekly taxol following 4 doses of doxorubicin and cyclophosphamide (AC) resulted in excessive pulmonary toxicity.

Thus, the use of concurrent breast RT and chemotherapy has appeal, but is currently not standard with RT and anthracyclines or taxanes.