Integration of Conservative Surgery, Radiotherapy, and Chemotherapy for Patients With Early-Stage Breast Cancer.

Abstract

A djuvant systemic therapy and the combination of breast-conserving surgery and radiotherapy are used with increasing frequency to treat patients with early-stage breast cancer. However, the optimal sequencing and timing of radiation and chemotherapy are unknown, both with regards to each other and to surgery. Some possibilities include giving all planned chemotherapy before radiation, all chemol therapy after radiation, giving both concurrently, or giving a portion of the chemotherapy before irradiation, and then completing chemotherapy afterward (“sandwich technique”). Trials of preoperative or “neoadjuvant” chemotherapy are underway as well. There are few data yet available to resolve such questions concerning treatment timing and sequencing. This article will discuss some aspects of this subject. The synergism or interaction of systemic therapy with radiotherapy in reducing the incidence of local recurrence will be explored. We will examine whether and to what extent the timing of radiotherapy and adjuvant systemic therapy in relation to surgery is related to their effectiveness in preventing local and distant failures, respectively. The sequencing of treatment modalities will then be assessed in relationship to tumor recurrence, cosmesis, and complication rates. The interactions of adjuvant tamoxifen with radiotherapy will also be addressed briefly.