Sequencing of chemotherapy and radiation in lymph node-negative breast cancer

PURPOSE To conduct a retrospective analysis of chemotherapy and radiation sequencin g in lymph node-negative breast cancer patients treated with breast-conserv ing surgery. PATIENTS AND METHODS Between February 1982 and January 1996, 124 patients with lymph node-negati ve breast cancer underwent breast-conserving surgery with axillary dissecti on followed by chemotherapy and radiation therapy. The outcome of 68 patien ts who received chemotherapy first was compared with that of 56 patients wh o received radiation first. The two groups were balanced with respect to pa tient age, tumor stage, margin status, and estrogen and progesterone recept or status. Sixty-two percent of the patients had T1 primary disease. The me dian follow-up among surviving patients was 44 months for the chemotherapy- first group and 61 months for the radiation-first group. RESULTS There were no statistically significant differences in local control, disea se-free survival, or overall survival between the two groups. Five-year act uarial rates for local central for the chemotherapy-first and the radiation -first groups were 100% and 94%, respectively. Five-year recurrence-free ra tes for the chemotherapy-first and radiation-first groups were 92% and 77%, respectively. The 5-year overall survival rate was 89% for both groups. DISCUSSION Giving chemotherapy before radiation in lymph node-negative breast cancer d id not compromise local control. Given the concerns about increased distant metastases if radiation is given first, the chemotherapy-radiation sequenc e is recommended.