Chemo and Radiation Before Surgery Seems to Reduce Risk of Recurrence for Certain Breast Cancers

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A study suggests that giving BOTH chemotherapy and radiation therapy before surgery to remove locally advanced breast cancer can help reduce the risk of the cancer coming back in the breast area (locoregional recurrence) in the 5 years after surgery. The results were presented at the 2010 annual meeting of the American Society for Radiation Oncology (ASTRO).

Locally advanced breast cancer is cancer that has spread beyond the breast to the chest wall or the skin on top of the breast.

To treat locally advanced breast cancer, it's common for doctors to use several treatments in sequence:

  • chemotherapy before surgery to weaken, shrink, or destroy the cancer cells (called neoadjuvant chemotherapy)
  • followed by surgery, usually mastectomy
  • followed by radiation therapy (radiation after surgery is called adjuvant radiotherapy)

Chemotherapy, targeted therapy, or hormonal therapy also may be used after surgery.

When only chemotherapy is given before surgery and radiation therapy is given after surgery, the risk of the cancer coming back in the breast area is 6% to 13%. In some cases, the cancer comes back in another part of the body away from the breast (metastatic recurrence) as well as the breast area. In other cases, the cancer only comes back in another part of the body.

In this study, the researchers wanted to see if using BOTH chemotherapy AND radiation therapy before surgery (called neoadjuvant chemoradiation) would reduce the risk of locally advanced breast cancer coming back in the breast area compared to only giving chemotherapy before surgery.

The researchers looked at the results of three small studies evaluating giving both chemotherapy and radiation before surgery in 105 women diagnosed with locally advanced breast cancer. The women were about 54 years old. About half of them were white and the rest were of other ethnicities.

  • 54% of the cancers were hormone-receptor-positive
  • 32% of the cancers were HER2-positive

Each woman received the chemotherapy medicine paclitaxel and radiation therapy before breast cancer surgery. After surgery, some of the women got more chemotherapy or hormonal therapy. None of the women got more radiation therapy after surgery.

Comparing tissue removed during the biopsy (when the women were diagnosed) to the tissue removed during surgery, the researchers found that about 33% of the cancers were weakened (called partial pathologic response) or had been destroyed (complete pathologic response) by the chemotherapy and radiation given before surgery.

Among the 105 women, only 5 women (5%) had the cancer come back in the breast area during the first 5 years after treatment. Four of these women had the cancer come back only in the breast area; one woman had the cancer come back in the breast area and in another part of the body away from the breast.

Other women had the cancer come back only in another part of the body away from the breast. Overall, 72% of the women were alive 5 years after treatment started.

These results suggest that chemotherapy AND radiation therapy before surgery is somewhat better than only chemotherapy before surgery (with radiation therapy after surgery) at reducing the risk of cancer coming back in the breast area in women diagnosed with locally advanced breast cancer (5% compared to 6% to 13%). Still, it's important to know that this study didn't compare directly a group of women who got chemotherapy and radiation therapy before surgery to a similar group of women who got only chemotherapy before surgery.

If you've been diagnosed with locally advanced breast cancer and are developing a treatment plan with your doctor, you might want to discuss this study as you plan. Chemotherapy before surgery may be part of your treatment. Ask your doctor if radiation therapy before surgery instead of after might make sense for your situation.

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