In Regard to Fernando et al.: Synchronous versus sequential chemo-radiotherapy in patients with early stage breast cancer (SECRAB): A randomised, phase III, trial

Abstract

We read the article entitled ‘‘Synchronous versus sequential chemo-radiotherapy in patients with early stage breast cancer (SECRAB): A randomised, phase III, trial” by Fernando et al. with great interest [ [1] Fernando I.N. Bowden S.J. Herring K. et al. Synchronous versus sequential chemo-radiotherapy in patients with early stage breast cancer (SECRAB): A randomised, phase III, trial. Radiother Oncol. 2020; 142: 52-61 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar ]. This is a large multicentric randomized phase III trial in which assessed the optimal sequence of adjuvant chemotherapy and radiotherapy (RT) in patients with early stage breast cancer. After a median follow-up of 10.2 years, 10-year local recurrence rates were significantly decreased in synchronous arm compared to sequential arm (4.6% vs. 7.1%, p = 0.012) without a significant difference in overall (OS) or disease-free survival. While, there was a significant increase in moderate or severe acute skin reactions in synchronous arm (24% vs. 14.8%, p < 0.0001), there were no significant differences in late adverse effects except for telangiectasia (3% vs. 1.7%, p = 0.03). Contrary to this study, the role of concomitant chemo-RT in breast cancer patients is controversial in the literature [ 2 Toledano A. Azria D. Garaud P. et al. Phase III trial of concurrent or sequential adjuvant chemoradiotherapy after conservative surgery for early-stage breast cancer: final results of the ARCOSEIN trial. J Clin Oncol. 2007; 25: 405-410 Crossref PubMed Scopus (71) Google Scholar , 3 Rouesse J. de la Lande B. Bertheault-Cvitkovic F. et al. A phase III randomized trial comparing adjuvant concomitant chemoradiotherapy versus standard adjuvant chemotherapy followed by radiotherapy in operable node-positive breast cancer: final results. Int J Radiat Oncol Biol Phys. 2006; 64: 1072-1080 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar , 4 Pinnaro P. Rambone R. Giordano C. Giannarelli D. Strigari L. Arcangeli G. Long-term results of a randomized trial on the sequencing of radiotherapy and chemotherapy in breast cancer. Am J Clin Oncol. 2011; 34: 238-244 Crossref PubMed Scopus (13) Google Scholar , 5 Pinnaro P. Giordano C. Farneti A. et al. Impact of sequencing radiation therapy and chemotherapy on long-term local toxicity for early breast cancer: results of a randomized study at 15-year follow-up. Int J Radiat Oncol Biol Phys. 2016; 95: 1201-1209 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. It results in an increase in both acute and late toxicity without a clear loco-regional benefit.