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document
The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer . BACKGROUND Patients with early-stage breast cancer who are at substantial risk for systemic metastases are increasingly treated with breast-conserving therapy and adjuvant chemotherapy . However , the optimal sequencing of chemotherapy and radiation therapy is not clear . METHODS Two hundred forty-four patients with stage I or II breast cancer who were at substantial risk for distant metastases were randomly assigned to receive a 12-week course of chemotherapy either before or after radiation therapy . All had had breast-conserving surgery . The median length of follow-up in surviving patients was 58 months ( range , 10 to 124 ) . RESULTS The five-year actuarial rates of cancer recurrence at any site and of distant metastases in the radiotherapy-first group and the chemotherapy-first group were 38 percent and 31 percent ( P = 0.17 ) and 36 percent and 25 percent ( P = 0.05 ) , respectively . Overall survival was 73 percent and 81 percent ( P = 0.11 ) , respectively . The five-year crude rates of first recurrence according to site in the radiotherapy-first and chemotherapy-first groups , respectively , were 5 percent and 14 percent for local recurrence and 32 percent and 20 percent for distant or regional recurrence or both . This difference in the pattern of recurrence was of borderline statistical significance ( P = 0.07 ) . CONCLUSIONS This study suggests that for patients ar substantial risk for systemic metastases , it is preferable to give a 12-week course of chemotherapy followed by radiation therapy , rather than radiation therapy followed by chemotherapy .
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Intervention_Pharmacological
breast-conserving therapy
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Intervention_Pharmacological
adjuvant chemotherapy
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Intervention_Pharmacological
chemotherapy
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Intervention_Pharmacological
radiation therapy
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Intervention_Pharmacological
12-week course of chemotherapy either before or after radiation therapy
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Intervention_Pharmacological
radiotherapy-first
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Intervention_Pharmacological
chemotherapy-first
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Intervention_Pharmacological
radiotherapy-first
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Intervention_Pharmacological
chemotherapy-first
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Intervention_Pharmacological
radiation therapy
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Intervention_Pharmacological
radiation therapy followed by chemotherapy
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Outcome_Physical
five-year actuarial rates of cancer recurrence
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Outcome_Mortality
Overall survival
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Outcome_Physical
five-year crude rates of first recurrence
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Outcome_Physical
pattern of recurrence
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Participant_Condition
breast cancer
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Participant_Condition
breast cancer
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Participant_Condition
metastases
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Participant_Sample-size
Two hundred forty-four
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Participant_Condition
breast cancer
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Participant_Condition
metastases
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Participant_Condition
metastases