Long-term follow-up of patients who received concurrent paclitaxel and radiation therapy after adjuvant doxorubicin and cyclophosphamide chemotherapy for stage II or III breast cancer at South Egypt Cancer Institute

Background: Adjuvant chemotherapy administration before breast irradiation decreases the risk of systemic recurrence, However, delaying the administration of radiotherapy after surgery could result in higher local failure. Concurrent chemoradiotherapy may yield better local control with minimal toxicity.
Methods: This retrospective study included 46 female patients with stage II or III breast cancer who underwent breast conservative surgery. Adjuvant chemotherapy administered was 4 cycles of AC (Doxorubicin 60 mg / m2 and Cyclophosphamide 600 mg / m2) followed by 4 cycles of Paclitaxel (175 mg / m2) given intravenously every 3 weeks. Adjuvant radiotherapy was given concurrently with the first 2 cycles of paclitaxel. The radiotherapy dose delivered was 50 Gy/ 25 fractions / 5 weeks to the whole breast with a tumor bed boost of 16 Gy. Regional lymphatics were included when indicated.
Results: In this study, the median follow-up period was 61 months, disease-free survival (DFS) was 86.6 %, overall survival was 89%, local recurrence was reported in only 2 patients (4.3%), and distant metastasis was reported in 4 patients (8.7%). There was no grade 2 or 3 toxicities 6 weeks after finishing radiotherapy. Late skin toxicity (telangiectasia, hyperpigmentation, and subcutaneous fibrosis) was assessed and showed that after 60 months of radiotherapy, most patients had grade 0 toxicity with no grade 2 or 3 toxicity. Cosmesis was evaluated and after 60 months of radiotherapy, 20 (46.5%) patients scored good, 15 (34.9%) excellent, 7 (16.3%) fair, and only one patient (2.3%) showed poor cosmesis. Regarding pulmonary toxicity, only 2 patients developed grade 3 acute radiation pneumonitis and as for chronic lung toxicity after 60 months of radiotherapy, 37 patients (86%) were grade 0 and had no grade 3 toxicity. Cardiac toxicity was evident in only 3 patients (6.5%). Regarding lymphedema, most patients that showed lymphedema were grade 1.
Conclusion: Our results confirm the efficacy and safety of concurrent paclitaxel with radiotherapy after AC chemotherapy in breast cancer patients in terms of acute and late toxicity and disease control.