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Interrupting Radiation Therapy for Triple-Negative Breast Cancer
The impact of treatment interruptions during courses of adjuvant radiation therapy for breast cancer has not been investigated. To address this issue, investigators conducted a study of 35,845 triple-negative breast cancer (TNBC) patients in the National Cancer Database who received external beam radiation and had overall survival (OS) of at least 12 months. Among these patients, 76% had grade III–IV disease and 68% had N0 cancer.
Multivariable Cox proportional hazard models were used to determine the association between interrupted treatment days and OS. The number of interrupted treatment days was defined as the total number of days from the start to the end of treatment minus the number of expected days of treatment. OS was defined as the time between the date of diagnosis and the date of death.
As the number of interrupted treatment days increased, OS progressively worsened. Compared with 0–1 interrupted treatment days, hazard ratios for poorer OS were 1.069 for 2–5 interrupted treatment days, 1.239 for 6–10 interrupted treatment days, and 1.265 for 11–15 interrupted treatment days. Other factors significantly associated with poorer OS were Black versus white race (HR, 1.278), other nonwhite versus white race (HR, 1.337), grade III–IV versus grade I disease (HR, 1.743), and stage N1–N3 versus N0 disease (HR, 2.534–4.992).
These results suggest that it may be better for patients to try to “push through” radiation-related toxicities rather than interrupt therapy. To that end, the investigators suggest exploring prophylactic measures and alternative therapies to minimize acute toxicities. Avoiding interruptions should especially be encouraged in patients with aggressive features, such as high-grade disease and node positivity, that negatively affect outcome. The results also raise the issue of whether social determinants of health (employment issues, family resources and support, transportation, etc.), especially in certain populations, amplify the effect of treatment interruptions.
Chow R et al.
Title: Effect of treatment interruptions on overall survival in patients with triple-negative breast cancer.
Source: J Natl Cancer Inst 2023 Sep 7; [e-pub]. (Abstract/FREE Full Text)