Feasibility of concurrent weekly paclitaxel and radiotherapy in adjuvant treatment of breast cancer: An experience from India.

Abstract

e11536 Background: Majority of the breast cancer patients require adjuvant radiotherapy and chemotherapy for better locoregional and distant control. However the sequencing of these is still debatable . Hence concurrent chemo radiation may avoid the delay in either of the adjuvant therapies. Anthracyclines are not used concurrently with radiation because of severe toxicity. Hence the current study was taken to assess the feasibility of concurrent weekly paclitaxel and radiotherapy in adjuvant treatment of ca breast. Methods: A prospective study was conducted on 22 breast cancer patients, post modified radical mastectomy or breast conservative surgery from November 2008 to April 2010. Chest wall or whole breast radiotherapy was given on Tele Cobalt or Linac for a dose of 50 – 50.4Gy in conventional fractionation. Boost of 16 Gy was given to tumor cavity with photons or electrons for those undergone breast conservative surgery. All patients received Inj.paclitaxel 60 mg/m2 once a week for 5 weeks. After completion of RT, paclitaxel dose was increased to 80mg/m2 for remaining 7 cycles. This was followed by anthracycline based treatment sequentially as per standard adjuvant guidelines. Patients assessed weekly and toxicities graded based on CTC version 03. The minimum follow up was 2 months after completion of chemoradiation. Chi-Square test and Fisher exact test were used to interpret the results with literature. Results: See table below. Skin reaction was more frequent and severe of all toxicities (p=0.003).With available literatures on adjuvant radiation alone the grade III and higher skin reactions are 3% but in our study it is 28% because of which 5/22 (22%) patients had interruption of both chemotherapy and radiation. Conclusions: Concurrent chemoradiation with weekly paclitaxel in adjuvant treatment of ca breast is associated with more skin reactions which may result in significant treatment interruptions. It should be practiced cautiously which requires further randomized control studies to assess the toxicities in detail. [Table: see text]