UTILITY OF SYNCHRONOUS CHEMO RADIOTHERAPY AS A VIABLE ALTERNATIVE TO SEQUENTIAL CHEMOTHERAPY AND RADIOTHERAPY (RT) AFTER BREAST CONSERVING SURGERY (BCS)

Omer Sager*, Murat Beyzadeoglu, Selcuk Demiral, Ferrat Dincoglan, Hakan Gamsiz, Bora Uysal

University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey

ABSTRACT

Breast cancer (Ca) is a very common cancer and an important reason for malignancy associated deaths around the globe. Treatment typically includes different sequencing and combinations of surgery, radiation therapy (RT) and systemic treatments. Selecting optimal surgical modality for a given patient takes into account several considerations such as patient and tumor characteristics, logistical issues, thorough assessment of expected treatment outcomes with incorporation of various treatment combinations, and patient preferences. From a scientific standpoint, accumulating evidence has demonstrated comparable efficacy of both surgical modalities. While BCS may be increasingly utilized for breast Ca therapy, it may not be adequate for achieving optimal treatment outcomes if used as the sole treatment modality for management. There is accumulating data suggesting a role for RT after BCS to achieve improved treatment outcomes with its incorporation as adjunct therapy. Chemotherapy and RT are delivered in a sequential fashion typically, nevertheless, optimal sequencing of these modalities has been the focus of active investigation. Synchronous use of adjuvant systemic treatment with RT after BCS allows for shortened treatment time without any delay in use of both modalities, and may exploit the biological interplay of both modalities to achieve a potentially greater anti-tumoral effect than that could be achieved by their sequential administration through different mechanisms such as radio sensitization. Vigilance is required for toxicity monitoring during the course of synchronous treatment, nevertheless, contemporary technologies including adaptive RT and breathing adapted RT may improve the toxicity profile of management. Clearly, further investigation is needed to shed light on optimal sequencing of treatment modalities after BCS. Herein, we evaluate the utility of synchronous chemo radiotherapy as a viable alternative to sequential administration after BCS.

Keywords:

synchronous, chemo radiotherapy, breast cancer (Ca), radiation therapy (RT)