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| |  Beth Israel Reports Benefits of Chemotherapy Given Before Radiation BOSTON, May 22, 1996 -- Women with early-stage breast cancer who have lumpectomies and are at substantial risk for metastasis, reduce the risk that their cancer will spread if they undergo chemotherapy before radiation therapy, according to a new report by researchers at Boston's Beth Israel Hospital and Harvard Medical School. The study in the May 23 New England Journal of Medicine (NEJM) is the first randomized trial to demonstrate that the timing of chemotherapy and radiation therapy can affect whether breast cancer spreads to other parts of the body or reappears in the breast itself. "The sequencing of what we call adjuvant therapy, such as chemotherapy and radiation therapy, is hotly debated in medicine," says Steven E. Come, MD, medical oncologist at Boston's Beth Israel Hospital and principal investigator of the study, Sequencing of Chemotherapy and Radiation Therapy after Conservative Surgery for Early-Stage Breast Cancer. "Our results demonstrate that for women in the early stages of breast cancer who have undergone breast-conserving surgery and for whom there is a significant likelihood their cancer will metastasize, giving chemotherapy before radiation therapy (rather than after radiation therapy) will probably prolong life." Typically, radiation therapy is given to control local recurrence of cancer, and chemotherapy is used to prevent the systemic spread of the disease. Normally, radiation therapy is administered for about six weeks, and chemotherapy takes between three and six months. But the issue for physicians has been whether to give radiation first, thus delaying chemotherapy and increasing the odds that the cancer will spread. Or, whether they should start chemotherapy first, but perhaps run the risk that a delay in starting radiation therapy will result in a recurrence of the tumor in the breast. In this randomized trial, conducted at Beth Israel and other Harvard teaching hospitals, 240 women with either stage I or stage II breast cancer, considered at substantial risk of developing cancer in other parts of the body, were assigned a 12-week course of chemotherapy either before or after radiation therapy. All patients had undergone breast-conserving surgery and were followed for an average of five years. Researchers found that 28 of the patients in the chemotherapy-first group and 42 patients in the radiation-therapy-first group developed cancers elsewhere in the body. The five-year rates of developing metastatic disease were 25 percent and 36 percent in the two groups respectively. In contrast, patients who received chemotherapy first had a 14 percent chance of the tumor reappearing in the breast, compared to five percent in patients who received radiation first. The researchers theorize that the rates of metastatic disease may have been greater in the radiation-first group because of the longer interval between surgery and the start of chemotherapy and possible also the lower drug doses given the radiation-first group. According to the lead author of the study, Abram Recht, MD, who is also a radiation oncologist at Beth Israel Hospital, the researchers have already begun studies of how to improve the results of treatment for future patients, by combining chemotherapy and radiotherapy in ways that minimize the risks of both local and distant recurrences. Other Harvard teaching hospitals involved in the study were Dana Farber Cancer Institute, Brigham and Women's Hospital, and Deaconess Hospital. Beth Israel Hospital, Boston, a major clinical, teaching, and research affiliate of Harvard Medical School, is the cornerstone of Beth Israel HealthCare, a regional system of care promoting lifelong well-being.
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