A new study presented at the 2011 European Multidisciplinary Cancer Congress has reported the results of SECRAB, a large, prospective trial concerning the timing of chemotherapy and radiotherapy after surgery for women with early stage breast cancer. Sequential treatment is the current standard; chemotherapy is given first followed by radiotherapy. The study enrolled 2,296 women between 1998 and 2004 who were randomly assigned to receive either sequential chemotherapy and radiotherapy or synchronous chemotherapy and radiotherapy (radiation treatments were given in the gaps between chemotherapy cycles).
A total of 1,285 of the women had breast conserving surgery such as lumpectomy and 1,011 underwent mastectomy. Each of the women received either cyclophosphamide/methotrexate/fluorouracil (CMF) or anthracycline-CMF chemotherapy. The radiation schedule was lighter in the synchronous chemoradiation group, with three weeks of radiation treatments compared to four or five weeks in the sequential group. The primary study endpoint was local breast cancer recurrence (i.e., recurrence in the same breast as the original tumor). The secondary study endpoint was quality of life, which was measured using two questionnaires. Quality of life questionnaires were completed by trial participants at baseline (before chemotherapy), end of all treatment, and one and two years after surgery. A total of 565 patients (who completed a total of 2,104 questionnaires) participated in this portion of the study.
The five-year local recurrence rates were 2.8% in the synchronous chemoradiation group and 5.1% in the sequential group. After a follow-up period of more than eight years, 41 women in the synchronous chemoradiation group had suffered a recurrence compared to 63 patients in the sequential group. Synchronous chemoradiation reduced the risk of local cancer recurrence by 35% in women with early stage breast cancer. No significant difference was found between the two groups in average quality of life score. Fatigue and trouble sleeping were the most commonly reported problems. An increase in acute skin toxicity was observed for women receiving synchronous chemoradiation, however, this was not reflected in the quality of life scores since the effects were for the most part relatively short lived. The authors conclude that synchronous chemoradiation reduces local recurrence and can be given without adversely affecting quality of life. Approximately one breast cancer death can be avoided for every four local recurrences prevented. The findings are expected to change treatment practice.