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Optimal Timing of Adjuvant Chemotherapy Following Breast Cancer Surgery

Patients should be encouraged to proceed to chemotherapy within 12 weeks of primary breast surgery.

For most women with early-stage breast cancer who will receive both postoperative radiation therapy and adjuvant chemotherapy (with or without adjuvant endocrine therapy), chemotherapy typically is administered before radiation therapy. For some patients, the interval from surgery to the start of chemotherapy is prolonged by various factors. Although a few reports have suggested that delays as long as 12 weeks do not compromise outcomes, data have not been available on outcomes after delays of longer than 12 weeks.

Researchers now report on a retrospective population-based study from the British Columbia Cancer Agency, in which survival was analyzed among 2594 patients with early-stage breast cancer, based on the length of time from definitive surgery to initiation of adjuvant chemotherapy (4 weeks, >4 to 8 weeks, >8 to 12 weeks, or >12 to 24 weeks). This study, conducted from 1989 through 1998, included patients who received adjuvant chemotherapy for stage I or II breast cancer; median follow-up was 6.2 years. Relapse-free survival (RFS) and overall survival (OS) were similar for women who started chemotherapy as long as 12 weeks after surgery; however, delays beyond 12 weeks resulted in compromised RFS and a statistically inferior OS.

Comment: Practice patterns demonstrate that most patients who are destined to receive adjuvant chemotherapy after surgery do so prior to receiving adjuvant radiation therapy. The results of this and similar studies reaffirm that initiation of chemotherapy as long as 12 weeks after surgery provides equivalent protection from recurrence and yields similar overall survival rates to starting chemotherapy within 4 weeks. The time after surgery often is consumed with coming to grips with the diagnosis of breast cancer, gathering information, and obtaining first and second opinions on continuing treatments. Although in this study the authors were not able to determine the factors that resulted in prolonged delays (>12 weeks) until the start of adjuvant chemotherapy, these data provide a strong argument for encouraging patients to proceed to chemotherapy within 12 weeks of primary breast surgery.

— William J. Gradishar, MD

Published in Journal Watch Oncology and Hematology November 6, 2006

Citation(s):

Lohrisch C et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 2006 Oct 20; 24:4888-94.

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