Sequencing of tamoxifen and radiotherapy after breast-conserving surgery in early-stage breast cancer.
Sequencing of tamoxifen and radiotherapy after breast-conserving surgery in early-stage breast cancer.
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DOI：
10.1200/jco.2005.01.198
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
Lori J Pierce;L. Hutchins;S. Green;D. Lew;J. Gralow;R. Livingston;C. Osborne;K. Albain
中科院分区：
文献类型：
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作者：
Lori J Pierce;L. Hutchins;S. Green;D. Lew;J. Gralow;R. Livingston;C. Osborne;K. Albain
目的 他莫昔芬 (TAM) 被认为对激素敏感的乳腺癌细胞具有细胞抑制作用。一些临床前研究表明，经 TAM 预处理后，受辐射的恶性乳腺上皮细胞的放射敏感性降低；其他研究反驳了这些结果。最近的随机临床试验表明，TAM 对细胞毒治疗具有拮抗作用，序贯 TAM 与同时 TAM 相比可改善无病生存 (DFS)。我们进行了一项探索性分析，以评估保乳手术后 TAM 和放疗 (RT) 的最佳顺序。患者和方法西南肿瘤学组试验 8897（组间 0102）将患有 T1-3 乳腺癌的淋巴结阴性女性随机分配至环磷酰胺、阿霉素、氟尿嘧啶 (CAF) 组； CAF --> TAM；环磷酰胺、甲氨蝶呤、氟尿嘧啶(CMF)；和 CMF --> TAM。对于此分析，仅报告 TAM 组中的数据。辅助治疗前（序贯 [SEQ] RT；107 名患者）或化疗后允许进行 RT，但与 TAM 同步（并发 [CONC] RT；202 名患者）。生存数据根据受体状态、年龄和肿瘤大小进行调整。结果 中位随访时间为 10.3 年，CONC 组与 SEQ RT 组的 10 年 DFS 值分别为 83% 和 83%（对数秩 P = .73；根据患者特征调整后的 P = .76），10 年总生存率分别为 88% 和 90%（对数秩 P = .59；调整后的 P = .65）。失败模式显示 CONC RT 和 SEQ RT 组之间的乳房内复发率没有增加，CONC RT 组的 10 年局部复发率为 7%，SEQ RT 组为 5%（风险比，0.73；95% CI，0.26 至 2.04；P = .54）。结论 目前的分析并未表明 CONC 与 SEQ TAM 和 RT 在淋巴结阴性乳腺癌中对局部或全身控制产生不利影响。鼓励进行随机试验来验证这些结果。
PURPOSE Tamoxifen (TAM) is thought to exert a cytostatic effect on hormone-sensitive breast cancer cells. Some preclinical studies show reduced radiosensitivity in irradiated malignant mammary epithelial cells when pretreated with TAM; other studies refute these results. Recent randomized clinical trials suggest an antagonistic effect of TAM on cytotoxic therapy, with improved disease-free survival (DFS) with sequential versus concurrent TAM. An exploratory analysis was undertaken to evaluate the optimal sequencing of TAM and radiotherapy (RT) after breast-conserving surgery. PATIENTS AND METHODS Southwest Oncology Group trial 8897 (Intergroup 0102) randomly assigned node-negative women with T1-3 breast cancers to cyclophosphamide, doxorubicin, fluorouracil (CAF); CAF --> TAM; cyclophosphamide, methotrexate, fluorouracil (CMF); and CMF --> TAM. For this analysis, data are reported only in the TAM groups. RT was allowed either before adjuvant therapy (sequential [SEQ] RT; 107 patients) or after chemotherapy but concurrent with TAM (concurrent [CONC] RT; 202 patients). Survival data were adjusted for receptor status, age, and tumor size. RESULTS With a median follow-up of 10.3 years, 10-year DFS values were 83% and 83% for CONC versus SEQ RT groups (log-rank P = .73; P = .76 adjusted for patient characteristics), and 10-year overall survivals were 88% and 90%, respectively (log-rank P = .59; adjusted P = .65). Patterns of failure showed no increase in in-breast recurrence rates between CONC RT and SEQ RT groups, with 10-year local recurrence rates of 7% for CONC RT and 5% for SEQ RT (hazard ratio, 0.73; 95% CI, 0.26 to 2.04; P = .54). CONCLUSION The current analysis does not suggest an adverse effect on local or systemic control with CONC versus SEQ TAM and RT in node-negative breast cancer. A randomized trial is encouraged to validate these results.