Impact of high-dose chemotherapy on the ability to deliver subsequent local-regional radiotherapy for breast cancer: Analysis of Cancer and Leukemia Group B Protocol 9082 Journal Article
| Authors: | Marks, L. B.; Cirrincione, C.; FitzGerald, T. J.; Laurie, F.; Glicksman, A. S.; Vredenburgh, J.; Prosnitz, L. R.; Shpall, E. J.; Crump, M.; Richardson, P. G.; Schuster, M. W.; Ma, J.; Peterson, B. L.; Norton, L.; Seagren, S.; Henderson, I. C.; Hurd, D. D.; Peters, W. P. |
| Article Title: | Impact of high-dose chemotherapy on the ability to deliver subsequent local-regional radiotherapy for breast cancer: Analysis of Cancer and Leukemia Group B Protocol 9082 |
| Abstract: | Purpose: To report, from Cancer and Leukemia Group B Protocol 9082, the impact of high-dose cyclophosphamide, cisplatin, and BCNU (HD-CPB) vs. intermediate-dose CPB (ID-CPB) on the ability to start and complete the planned course of local-regional radiotherapy (RT) for women with breast cancer involving ≥10 axillary nodes. Methods and Materials: From 1991 to 1998, 785 patients were randomized. The HD-CPB and ID-CPB arms were balanced regarding patient characteristics. The HD-CPB and ID-CPB arms were compared on the probability of RT initiation, interruption, modification, or incompleteness. The impact of clinical variables and interactions between variables were also assessed. Results: Radiotherapy was initiated in 82% (325 of 394) of HD-CPB vs. 92% (360 of 391) of ID-CPB patients (p = 0.001). On multivariate analyses, RT was less likely given to patients who were randomized to HD treatment (odds ratio [OR] = 0 .38, p < 0.001), older (p = 0.005), African American (p = 0.003), postmastectomy (p = 0.02), or estrogen receptor positive (p = 0.03). High-dose treatment had a higher rate of RT interruption (21% vs. 12%, p = 0.001, OR = 2.05), modification (29% vs. 14%, p = 0.001, OR = 2.46), and early termination of RT (9% vs. 2%, p = 0.0001, OR = 5.35), compared with ID. Conclusion: Treatment arm significantly related to initiation, interruption, modification, and early termination of RT. Patients randomized to HD-CPB were less likely to initiate RT, and of those who did, they were more likely to have RT interrupted, modified, and terminated earlier than those randomized to ID-CPB. The observed lower incidence of RT usage in African Americans vs. non-African Americans warrants further study. © 2010 Elsevier Inc. All rights reserved. |
| Keywords: | adult; controlled study; aged; middle aged; major clinical study; clinical trial; cisplatin; doxorubicin; fluorouracil; cancer combination chemotherapy; cancer radiotherapy; chemotherapy; drug megadose; follow-up studies; lymphatic metastasis; controlled clinical trial; breast cancer; mastectomy; randomized controlled trial; antineoplastic combined chemotherapy protocols; radiotherapy dosage; radiotherapy; cyclophosphamide; breast neoplasms; carmustine; probability; tamoxifen; multivariate analysis; platinum compounds; estrogen receptor; toxicity; decision making; multi variate analysis; multivariant analysis; analysis of variance; canada; ethnicity; african american; high dose; high-dose chemotherapy; axillary nodes; cis-platin; early termination; high-dose chemotherapies; high-dose treatment; odds ratios; breakwaters |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 76 |
| Issue: | 5 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2010-04-01 |
| Start Page: | 1305 |
| End Page: | 1313 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2009.04.013 |
| PUBMED: | 19747781 |
| PROVIDER: | scopus |
| PMCID: | PMC3670136 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: IOBPD" - "Source: Scopus" |
