Study finds best way to give radiotherapy after breast cancer surgery

In collaboration with the Press Association

A Cancer Research UK-funded study has shown that giving radiotherapy between or during chemotherapy cycles to women with early breast cancer significantly reduces the risk of the disease returning.

Chemotherapy is usually given after breast cancer surgery, followed by radiotherapy, to destroy any remaining cancer cells in the breast, chest wall or underarm area.

But researchers found that synchronous chemoradiation - where radiotherapy is given between or during chemotherapy cycles - reduced the risk of the cancer recurring by 35 per cent among women in the early stages of the disease.

The SEquencing of Chemotherapy and Radiotherapy in Adjuvant Breast cancer (SECRAB) is the largest ever study into synchronous chemoradiation.

The optimal timing of radiotherapy with chemotherapy has been a subject of debate among cancer experts. The SECRAB trial aimed to find out the best schedule for giving radiotherapy with cyclophosphamide/methotrexate/fluorouracil (CMF) or anthracycline-CMF chemotherapy after surgery to women with early breast cancer.

The trial involved 2,296 women who had undergone tumour removal surgery or a mastectomy.

Researchers found that eight years after treatment, cancer returned in the breast or chest wall of 41 patients who were given synchronous chemoradiation.

This was compared with 63 patients who had received the standard sequence of chemotherapy followed by radiotherapy.

Patients in the synchronous chemoradiation group had a significantly worse skin reaction to their treatment. But only four per cent of patients in the synchronous treatment group had a severe reaction that would have taken several weeks to heal and subsequently affect quality of life.

The majority of women had a moderate skin reaction that would have settled in a very short period of time and this had no detrimental effect on their quality of life.

The findings were presented at the European Multidisciplinary Cancer Congress in Stockholm.

Professor Michael Baumann, president of the European Cancer Organisation, 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."

Study leader Dr Indrajit Fernando, a consultant clinical oncologist at University Hospitals Birmingham NHS Foundation Trust, said the results could pave the way for shorter treatment courses, which would minimise disruption to the lives of women affected by breast cancer.

Dr Fernando said: "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."

He added: "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 in the UK but the results have implications worldwide."

Liz Woolf, head of Cancer Research UK's patient information website CancerHelp UK, said: "Breast cancer that has come back after treatment is always harder to treat and it's encouraging to hear that giving radiotherapy and chemotherapy together can reduce the likelihood of this.

"An added benefit of this for patients is that the overall duration of treatment will be shorter. The standard chemotherapy for breast cancer has changed since this study was carried out and it will be interesting to see if these results are reflected when the latest treatments are used."

Copyright Press Association 2011