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 >or=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.

• Authors: Lawrence B Marks, Constance Cirrincione, Thomas J Fitzgerald, Frances Laurie, Arvin S Glicksman, James Vredenburgh, Leonard R Prosnitz, Elizabeth J Shpall, Michael Crump, Paul G Richardson, Michael W Schuster, Jinli Ma, Bercedis L Peterson, Larry Norton, Steven Seagren, I Craig Henderson, David D Hurd, William P Peters, Cancer and Leukemia Group B, Southwest Oncology Group, National Cancer Institute of Canada Clinical Trials Group
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 76 Issue 5 Pg. 1305-13 (Apr 2010) ISSN: 1879-355X [Electronic] United States
• PMID: 19747781 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Doxorubicin
• Cyclophosphamide
• Cisplatin
• Fluorouracil
• Carmustine

Topics

• Adult
• Aged
• Analysis of Variance
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Breast Neoplasms (drug therapy, ethnology, pathology, radiotherapy)
• Canada
• Carmustine (administration & dosage)
• Cisplatin (administration & dosage)
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Female
• Fluorouracil (administration & dosage)
• Follow-Up Studies
• Humans
• Lymphatic Metastasis
• Middle Aged
• Multivariate Analysis
• Radiotherapy Dosage