Taxanes are widely used in adjuvant treatment of node positive breast cancer.Studies have shown that weekly Paclitaxel has better tumor response than 3 weekly regimens. Our study focussed on the feasibility of concurrent weekly paclitaxel and radiotherapy in adjuvant treatment of node positive ca breast patients.
To study the toxicity of concurrent weekly Paclitaxel and radiation
A prospective non randomised study was done on 22 female breast cancer patients undergoing adjuvant treatment after surgery by taking informed consent. External beam RT was given for a dose of 50Gy - 50.4Gy in 25-28 fractions .A boost dose of 16 Gy in 8 fractions was given for patients with breast conservative surgery. All patients received Inj. Paclitaxel 60 mg/m2 once a week for 5 weeks during RT. After completion of RT, Paclitaxel dose was increased to 80mg/m2 for 7 cycles. This was followed by 3 cycles of AC. Weekly clinical examination was done to assess the toxicity and graded as per RTOG criteria. All patients were followed up to 2 months after the completion of the concurrent chemoradiation. Chi square test and Fisher exact test were used for analyses
8 (36 %) patients developed grade I, 7(32%) developed grade II, 6(28%) developed grade III and 1 developed grade IV skin reaction. There was an increased frequency of higher skin reactions in patients treated with electrons (p=0.145). Diabetic patients had more severe skin reaction and longer healing time (p=0.03). With available literature on grade III and higher skin reaction with radiation alone is only 3% but in our study it is 28%. 5/22 (23%) patients had interruption of RT+CT which ranged from 5 days to 30 days
Conclusions:Concurrent chemoradiation with weekly paclitaxel and radiotherapy in adjuvant treatment of ca breast causes high skin reactions resulting in significant treatment interruptions.