Secuenciación de la quimioterapia y la radioterapia para el cáncer de mama temprano
Información
- DOI:
- https://doi.org/10.1002/14651858.CD005212.pub3Copiar DOI
- Base de datos:
-
- Cochrane Database of Systematic Reviews
- Versión publicada:
-
- 30 abril 2013see what's new
- Tipo:
-
- Intervention
- Etapa:
-
- Review
- Grupo Editorial Cochrane:
-
Grupo Cochrane de Cáncer de mama
- Copyright:
-
- Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
Altmetric:
Citado por:
Autores
Contributions of authors
BH and ML both contributed to writing the protocol, data extraction, analysis and writing of the discussion.
DF wrote the search strategy for the initial version, as well as in the update, and contributed to data extraction, analysis and writing of the paper.
Sources of support
Internal sources
-
Princess Alexandra Hospital Cancer Collaborative Group, Australia.
External sources
-
No sources of support supplied
Declarations of interest
None known.
Acknowledgements
We would like to acknowledge:
-
Yolanda Madarnas for kindly translating one of the included trials from French to English;
-
Mike Clarke and the UK Cochrane centre for the extremely useful advice and input we received;
-
Sharon Parker and the Cochrane Breast Cancer Review Group for valuable advice and assistance throughout the review process;
-
Adrienne See checked our data extraction.
Version history
| Published | Title | Stage | Authors | Version |
| 2013 Apr 30 | Sequencing of chemotherapy and radiotherapy for early breast cancer | Review | Brigid E Hickey, Daniel P Francis, Margot Lehman | |
| 2006 Oct 18 | Sequencing of chemotherapy and radiation therapy for early breast cancer | Review | Brigid E Hickey, Daniel P Francis, Margot Lehman | |
| 2005 Apr 20 | Sequencing of chemotherapy and radiation therapy for early breast cancer | Protocol | Margot Lehman, Brigid Hickey, Tiffany Daly, Daniel P Francis | |
Differences between protocol and review
We have reported the late effect cosmesis (where available) although we did not specify that we would do so in our protocol. Where information has allowed us to present HRs, we have done so.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Anemia [etiology];
- Breast Neoplasms [*drug therapy, mortality, *radiotherapy, surgery];
- Chemotherapy, Adjuvant [adverse effects, *methods];
- Pigmentation Disorders [etiology];
- Radiotherapy, Adjuvant [adverse effects, *methods];
- Randomized Controlled Trials as Topic;
- Telangiectasis [etiology];
- Time Factors;
Medical Subject Headings Check Words
Female; Humans;
Study flow diagram (updated search results to 14 December 2011).
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Comparison 1 Concurrent versus sequential (chemotherapy first), Outcome 1 Local recurrence‐free survival.
Comparison 1 Concurrent versus sequential (chemotherapy first), Outcome 2 Relapse‐free survival.
Comparison 1 Concurrent versus sequential (chemotherapy first), Outcome 3 Compliance with chemotherapy.
Comparison 1 Concurrent versus sequential (chemotherapy first), Outcome 4 Overall survival.
Comparison 1 Concurrent versus sequential (chemotherapy first), Outcome 5 Metastasis‐free survival.
Comparison 2 Radiotherapy then chemotherapy versus chemotherapy then radiotherapy, Outcome 1 Overall survival.
Comparison 2 Radiotherapy then chemotherapy versus chemotherapy then radiotherapy, Outcome 2 Metastasis‐free survival.
Comparison 2 Radiotherapy then chemotherapy versus chemotherapy then radiotherapy, Outcome 3 Relapse‐free survival.
Comparison 2 Radiotherapy then chemotherapy versus chemotherapy then radiotherapy, Outcome 4 Cosmesis.
| Cosmetic score |
| Excellent |
| Good |
| Fair |
| Poor |
| Type of outcome | Category | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
| Subjective | Pain | Occasional and minimal, hypersensation, pruritus | Intermittent and tolerable | Persistent and intense | Refractory and excruciating |
| Objective | Oedema | Asymptomatic | Symptomatic | Secondary dysfunction | ‐ |
| Fibrosis | Barely palpable, increased density | Definite increased density and firmness | Very marked increased density, retraction and fixation | ‐ | |
| Telangiectasia | < 1 cm2 | 1 to 4 cm2 | > 4 cm2 | ‐ | |
| Lymphoedema | 2 to 4 cm | > 4 to 6 cm | > 6 cm | Useless arm | |
| Atrophy/retraction | 10% to 25% | > 25% to 40% | > 40% to 75% | Whole breast | |
| Ulcer | Epidermal only ≤ 1 cm2 | Dermal > 1 cm | Subcutaneous | Bone exposed/necrosis | |
| Management | Pain | Occasional, non‐narcotic | Regular narcotic | Regular narcotic medical intervention | Surgical intervention |
| Oedema | ‐ | ‐ | Medical intervention | Surgical intervention/mastectomy | |
| Lymphoedema arm | ‐ | Elevate arm, elastic stocking | Compression wrapping, intensive physiotherapy | Surgical intervention/amputation | |
| Atrophy | ‐ | Surgical intervention/mastectomy | |||
| Ulcer | ‐ | Medical intervention | Surgical intervention/debridement | Surgical intervention/mastectomy | |
| Analytic | Photographic assessment of skin change | Yes/no | Date: | ‐ | ‐ |
| Tape measurement of breast size and arm diameter | Yes/no | Date: | ‐ | ‐ | |
| Mammogram assessment of skin thickness and density | Yes/no | Date: | ‐ | ‐ | |
| Yes/no | Date: computer tomography/magnetic resonance imaging assessment of size, fat atrophy, fibrosis | Yes/no | Date: | ‐ | ‐ |
| Pigmentation scoring scale |
| Excellent |
| Good |
| Moderate |
| Poor |
| Very poor |
| Cosmetic score |
| Excellent |
| Good |
| Acceptable |
| Poor |
| Very poor |
| Category | Description |
| Very poor | Very marked density, retraction, fixation and breast asymmetry 40% to 75% |
| Poor | Marked distortion of nipple, breast asymmetry 25% to 40%, marked contour difference, severe hyperpigmentation, severe oedema, marked mammillary deviation |
| Acceptable | Moderate distortion of nipple, absent nipple‐areola complex, breast asymmetry 10% to 25%, telangiectasia, moderate hyperpigmentation, increased density and firmness, slight oedema, prominent scar with surrounding retraction/volume loss, moderate contour difference, moderate mammillary deviation |
| Good | Minimal differences between treated and untreated breast, slight distortion of nipple, mild hyperpigmentation, breast asymmetry < 10%, mild telangiectasia |
| Very good | Treated breast looks almost identical to untreated breast, perfect symmetry, no visible distortion |
| Type of toxicity | Trials | Concurrent | Sequential | OR (95% CI) |
| Anaemia | ARCOSEIN | 111/352 | 81/358 | 1.54 (1.10 to 2.15) |
| Grade II/IV skin | ARCOSEIN | 13/107 | 11/107 | 1.21 (0.51 to 2.83) |
| Grade III/IV infection | ARCOSEIN | 1/107 | 3/107 | 0.33 (0.03 to 3.20) |
| Grade III/IV neutropenia | ARCOSEIN | 19/107 | 25/107 | 0.71 (0.36 to 1.38) |
| Nausea or vomiting | ARCOSEIN | 235/352 | 248/343 | 0.77 (0.56 to 1.06) |
| Grade III/IV oesophagitis | ARCOSEIN | 3/107 | 0/107 | 7.20 (0.37 to 141.12) |
| CI: confidence interval; OR: odds ratio. | ||||
| Toxicity type | Study | Concurrent | Sequential | OR (95% CI) |
| Atrophy | ARCOSEIN | 19/107 | 10/107 | 2.09 (0.92 to 4.75) |
| Telangiectasia | ARCOSEIN | 17/107 | 5/107 | 3.85 (1.37 to 10.87) |
| Fibrosis | ARCOSEIN | 6/107 | 0/107 | 13.77 (0.77 to 247.54) |
| Lymphoedema | ARCOSEIN | 2/107 | 1/107 | 2.02 (0.18 to 22.61) |
| Pigmentation | ARCOSEIN | 12/105 | 1/106 | 13.55 (1.73 to 106.19) |
| CI: confidence interval; OR: odds ratio. | ||||
| Cosmetic outcome | Study | Concurrent | Sequential | Physician‐reported OR (95% CI) | Participant‐reported OR (95% CI) |
| Bad or very bad overall cosmesis | ARCOSEIN | Physician 43/107 Participant 9/107 | Physician 16/107 Participant 8/107 | 3.82 (1.98 to 7.37) | 1.14 (0.42 to 3.07) |
| Poor/very poor skin colour | ARCOSEIN | Physician 14/107 Participant 3/107 | Physician 1/107 Participant 1/107 | 15.96 (2.06 to 123.68) | 3.06 (0.31 to 29.87) |
| Poor/very poor scar | ARCOSEIN | Physician 24/107 Participant 17/107 | Physician 15/107 Participant 12/107 | 1.77 (0.87 to 3.61) | 1.50 (0.68 to 3.31) |
| CI: confidence interval; OR: odds ratio. | |||||
| Toxicity type | Study | RT then CT | CT then RT | OR (95% CI) |
| Neutropenic sepsis | Bellon 2005 | 21/122 | 8/122 | 2.96 (1.26 to 6.98) |
| Pneumonia | 6/122 | 1/122 | 6.26 (0.74 to 52.79) | |
| Haemoglobin (CTC Grade III/IV) | 3/114 | 4/120 | 0.78 (0.17 to 3.58) | |
| Platelet (CTC Grade III/IV) | 0/114 | 3/120 | 0.15 (0.01 to 2.87) | |
| Skin (CTC Grade III/IV) | 17/115 | 12/112 | 1.45 (0.66 to 3.18) | |
| CI: confidence interval; CT: chemotherapy; CTC: common toxicity criteria; OR: odds ratio; RT: radiotherapy. | ||||
| Toxicity type | Study | RT then CT | CT then RT | OR (95% CI) |
| Pneumonitis | Bellon 2005 | 5/122 | 0/122 | 11.47 (0.63 to 209.70) |
| Cosmesis | 26/39 | 23/38 | 1.30 (0.51 to 3.31) | |
| Cardiac | 0/113 | 0/118 | ||
| Cellulitis | 6/117 | 3/119 | 2.09 (0.051 to 8.56) | |
| Lymphoedema | 8/117 | 4/119 | 2.11 (0.67 to 7.21) | |
| Brachial plexopathy | 1/42 | 0/43 | 3.14 (0.12 to 79.39) | |
| CI: confidence interval; CT: chemotherapy; OR: odds ratio; RT: radiotherapy. | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Local recurrence‐free survival Show forest plot | 1 | Hazard Ratio (95% CI) | Subtotals only | |
| 1.1 Local recurrence‐free survival at 5 years | 1 | 0 | Hazard Ratio (95% CI) | 0.96 [0.14, 6.82] |
| 1.2 Local recurrence‐free survival at 10 years | 1 | 0 | Hazard Ratio (95% CI) | 1.05 [0.30, 3.62] |
| 2 Relapse‐free survival Show forest plot | 2 | Hazard Ratio (95% CI) | Subtotals only | |
| 2.1 Relapse‐free survival HR at 5 years | 2 | 0 | Hazard Ratio (95% CI) | 0.98 [0.84, 1.15] |
| 3 Compliance with chemotherapy Show forest plot | 2 | 901 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.57 [0.35, 0.92] |
| 4 Overall survival Show forest plot | 2 | Hazard Ratio (95% CI) | Subtotals only | |
| 4.1 Overall survival at five years | 2 | 901 | Hazard Ratio (95% CI) | 0.97 [0.83, 1.13] |
| 5 Metastasis‐free survival Show forest plot | 2 | Hazard Ratio (95% CI) | Subtotals only | |
| 5.1 Metastasis‐free survival at 5 years | 2 | 0 | Hazard Ratio (95% CI) | 0.86 [0.60, 1.24] |
| 5.2 Metastasis‐free survival at 10 years | 1 | 0 | Hazard Ratio (95% CI) | 0.57 [0.20, 1.62] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Overall survival Show forest plot | 1 | Hazard Ratio (95% CI) | Subtotals only | |
| 1.1 Overall survival at 5 years | 1 | 0 | Hazard Ratio (95% CI) | 1.52 [0.90, 2.55] |
| 1.2 Overall survival at 10 years | 1 | 0 | Hazard Ratio (95% CI) | 1.20 [0.76, 1.89] |
| 2 Metastasis‐free survival Show forest plot | 1 | Hazard Ratio (95% CI) | Subtotals only | |
| 2.1 Distant metastases at 5 years | 1 | 0 | Hazard Ratio (95% CI) | 1.62 [1.00, 2.61] |
| 2.2 Distant metastases at 10 years | 1 | 0 | Hazard Ratio (95% CI) | 1.08 [0.71, 1.64] |
| 3 Relapse‐free survival Show forest plot | 1 | Hazard Ratio (95% CI) | Subtotals only | |
| 3.1 Relapse‐free survival at 5 years | 1 | 0 | Hazard Ratio (95% CI) | 1.37 [0.88, 2.14] |
| 3.2 Relapse‐free survival at 10 years | 1 | 0 | Hazard Ratio (95% CI) | 1.03 [0.73, 1.46] |
| 4 Cosmesis Show forest plot | 1 | 77 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.30 [0.51, 3.31] |
