A major UK trial led by University Hospitals Birmingham NHS Foundation Trust (UHB) has produced firm evidence that giving radiotherapy between or during chemotherapy cycles significantly reduces the risk of breast cancer returning.

Chemotherapy is usually given after breast cancer surgery, followed by radiotherapy, to destroy any remaining cancer cells in the breast, chest wall or underarm area.

But researchers found that synchronous chemoradiation - where radiotherapy is given between or during chemotherapy cycles - reduced the risk of the cancer recurring by 35 per cent among women in the early stages of the disease, without worsening side effects.

Study leader Dr Indrajit Fernando, Consultant Clinical Oncologist at UHB and Honorary Senior Lecturer at the University of Birmingham, said:  “The results show that synchronous chemoradiation reduces the risk of local cancer recurrence by 35 per cent in women with early breast cancer.

“After a follow-up of over eight years, only 41 patients in the synchronous chemoradiation group had suffered a recurrence, compared with 63 patients in the sequential chemoradiation group,”

He said the results could pave the way for shorter treatment courses, which would minimise disruption to the lives of women affected by breast cancer.

The SEquencing of Chemotherapy and Radiotherapy in Adjuvant Breast cancer (SECRAB) study was carried out at 48 centres in the UK and is the largest study to investigate the treatment.

Dr Fernando said: “The five-year local recurrence rates were 2.8 per cent and 5.1 per cent in the synchronous and sequential chemoradiation groups, respectively. This difference of 2.3 per cent between treatment groups was statistically significant.”

He added: “According to the Early Breast Cancer Trialists' Collaborative Group (EBCTCG), one breast cancer death can be avoided for every four local recurrences prevented. Therefore, even a 2.3 per cent reduction in local recurrence rates will have an impact worldwide when we consider that this is a very common cancer.”

The optimal timing of radiotherapy with chemotherapy has been a subject of debate among cancer experts. The aim of this trial was to determine the best schedule for giving radiotherapy with cyclophosphamide/methotrexate/fluorouracil (CMF) or anthracycline–CMF chemotherapy after surgery to women with early breast cancer.

This randomised Phase III trial enrolled 2,296 women who had undergone breast conserving surgery (1,285 women) or mastectomy (1,011 women) to remove their tumour. All the patients received chemoradiation after surgery, either sequential (1,146 patients) or synchronous, where the radiotherapy was given in the gaps between chemotherapy cycles (1,150 patients). More than 60 per cent of patients received 40Gy in 15 fractions over three weeks.

The results of the study were presented in Stockholm to delegates at the 2011 European Multidisciplinary Cancer Congress. Dr Fernando also presented results from research into the quality of life of patients in the SECRAB study. These focused on skin reactions caused by the radiotherapy, breast and arm symptoms and overall quality of life.

A total of 565 patients contributed to the quality of life analysis. Overall, the results showed that there were no observed differences in quality of life between the synchronous and sequential chemoradiation groups.

 “Although the results of the main study showed that patients in the synchronous chemoradiation group had a significantly worse skin reaction, only 4 percent of patients in the synchronous arm had a severe reaction which would have taken several weeks to heal and subsequently affect quality of life,” said Dr Fernando.

“The majority of women had a moderate skin reaction which would have settled in a very short period of time and this had no detrimental effect on their quality of life.

“Our data have shown that the acute skin toxicity of radiotherapy treatment was significantly less in patients being treated with three weeks of synchronous radiotherapy (40Gy radiation in 15 fractions) compared to those with schedules of a longer duration (45Gy in 20 fractions over four weeks or 50Gy in 25 fractions over five weeks). Importantly, the clinical benefit of synchronous chemoradiation treatment was seen in both patient groups.”

Dr Fernando said that the trial could be important for economic reasons: “Shortening the overall treatment time may mean that when patients have finished their last chemotherapy course they can return to their normal life without having to then complete their radiotherapy. This may also have economic benefits in terms of when patients can return to work.

“Clinical practice needs to be reviewed for patients who are being treated with a CMF or an anthracycline/CMF chemotherapy schedule. The data will be forwarded to the National Institute of Clinical Excellence (NICE) in the UK but the results have implications worldwide,” Dr Fernando added.