optimal sequence for various treatments (rads, chemo, hormonal)

dancetrancer

I just read this article and wanted to share it, b/c I felt it was excellent and easy to read and understand.  

Optimal Sequence of Implied Modalities in the Adjuvant Setting of Breast Cancer Treatment: An Update on Issues To Consider 

CONCLUSIONS

Recent evidence has clarified that a RT delay when given as sole modality in the adjuvant setting after BCS should be avoided; RT should be administered within a time frame of 6-20 weeks; therefore, departmental planning should focus on the shortening of waiting/"programming" lists. As far as the sequence of RT with chemoT is concerned, although data do not prove the superiority of any modality given first, it is now common practice that chemoT is administered before RT; it is however important in this context not to administer RT in a delay longer than 7 months after surgery. As far as the sequence of HT with chemoT is concerned, their combination should be avoided to avoid unnecessary toxicity; currently, the only available data have shown it is safer to administer tamoxifen after chemoT completion. The combination of hormone agents with RT seems to be safe and possibly even more effective for letrozole, whereas there is a trend of data showing a slightly increased toxicity of concurrent tamoxifen and RT.

Finally, the issue of the optimal combination of trastuzumab with chemoT and RT and even HT needs to be addressed in a randomized way, since there are hints suggesting a possible synergistic role, albeit with possibly increased toxicity. As data show it might be safe to use trastuzumab concurrently with RT, a definitive answer must be given soon in order to not miss the possible clinical benefit for reasons of prudence.

 

chatsworthgirl

Thank you so much for posting this.  I have been quite concerned about the delay in my beginning radiation.  The long delay was caused by great controversy over whether or not I needed it.  After six doctors looking at my case, I wound up with two nos and four yesses.  My final surgery - bi lateral mast - was on September 15, 2011 so I am coming up on seven months.

I am hugely relieved that I am not too late.  I begin radiation next week.

Kathy