TY - JOUR
T1 - Impact of High-Dose Chemotherapy on the Ability to Deliver Subsequent Local-Regional Radiotherapy for Breast Cancer
T2 - Analysis of Cancer and Leukemia Group B Protocol 9082
AU - Marks, Lawrence B.
AU - Cirrincione, Constance
AU - Fitzgerald, Thomas J.
AU - Laurie, Frances
AU - Glicksman, Arvin S.
AU - Vredenburgh, James
AU - Prosnitz, Leonard R.
AU - Shpall, Elizabeth J.
AU - Crump, Michael
AU - Richardson, Paul G.
AU - Schuster, Michael W.
AU - Ma, Jinli
AU - Peterson, Bercedis L.
AU - Norton, Larry
AU - Seagren, Steven
AU - Henderson, I. Craig
AU - Hurd, David D.
AU - Peters, William P.
N1 - Funding Information:
Conflict of interest: L.B.M. receives honoraria from Varian Medical Systems, and grants from the National Institutes of Health, the Lance Armstrong Foundation, and the U.S. Department of Defense. P.G.R. receives an honorarium from Millennium Pharmaceuticals.
Funding Information:
Supported by National Cancer Institute (NCI) Grants CA31946 (to Cancer and Leukemia Group B [CALBG], Richard L. Schilsky, Chairman), CA33601 (to the CALGB Statistical Center, Stephen George, Director), CA29511 (to the Quality Assurance Review Center), CA47577 (to J.V. and L.R.P.), CA42777 (to E.J.S.), CA77202 (to M.C.), CA32291 (to P.G.R.), CA35279 (to M.W.S.), CA77651 (to L.N.), CA11789 (to S.S.), CA60138 (to I.C.H.), CA03927 (to D.D.H.), and CA14028 (to W.P.P.). This manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NCI.
PY - 2010/4
Y1 - 2010/4
N2 - 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.
AB - 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.
KW - Breast cancer
KW - High-dose chemotherapy
KW - Radiotherapy
KW - Toxicity
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U2 - 10.1016/j.ijrobp.2009.04.013
DO - 10.1016/j.ijrobp.2009.04.013
M3 - Article
C2 - 19747781
AN - SCOPUS:77949556764
SN - 0360-3016
VL - 76
SP - 1305
EP - 1313
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -