In Reply to D. N. Sharma et al

Abstract

To the Editor: With interest we have read the comment by Sharma et al on our paper “Sequence of radiotherapy and chemotherapy in breast cancer after breast-conserving sur-gery” (1Jobsen J.J. van der Palen J. Brinkhuis M. et al.Sequence of radiotherapy and chemotherapy in breast cancer after breast-conserving surgery.Int J Radiat Oncol Biol Phys. 2012; 82: e811-e817Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 2Sharma D.N. Rath G.K. Julka P.K. In regard to Jobsen et al.Int J Radiat Oncol Biol Phys. 2013; 85: 289-290Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar). The authors comment on the observed differences among the 3 groups, in particular with respect to distant metastases and survival. They seem to accept it for the local control. As we mentioned in the discussion (1Jobsen J.J. van der Palen J. Brinkhuis M. et al.Sequence of radiotherapy and chemotherapy in breast cancer after breast-conserving surgery.Int J Radiat Oncol Biol Phys. 2012; 82: e811-e817Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar), we also noted this difference. We suggested that a difference in distant metastases and survival probability may be possible. We extensively discussed this item and suggested that one should expect a better outcome for group C. On the other hand, we want to stress that Cox regression multivariate analyses have been done, showing a significant difference. With respect to the comments on the details of the chemotherapy, we are aware of the differences in efficacy between the various chemotherapy regimens. However, the observed (absolute) differences in efficacy, as reported in the randomized controlled trials, are limited. One should also bear in mind that, over the years different regimens have been used, resulting in possible diverse chemotherapy details with no clear outcome. Despite the comments made by Sharma et al, we find that radiation therapy for breast-conserving therapy is as an integral part of the primary treatment and should be administered first, followed by adjuvant systemic therapy (if indicated). This is supported by the review studies mentioned in the papers and is even more feasible since the introduction of hypofractionated radiation therapy schemes. In Regard to Jobsen et alInternational Journal of Radiation Oncology, Biology, PhysicsVol. 85Issue 2PreviewTo the Editor: We read with great interest the article by Jobsen et al (1) regarding the sequencing of adjuvant radiation therapy (RT) and chemotherapy (CT) after the breast conservation surgery (BCS) in early breast cancer (EBC). Although this is a retrospective study, it has a good sample size of 641 patients. with sufficient statistical power, and will definitely draw the attention of the breast cancer therapists, as there has been no randomized trial since the study by Recht et al (2) in 1996. Full-Text PDF