Background:
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.
Aim:
To study the toxicity of concurrent weekly Paclitaxel and radiation
Methods:
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
Results:
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.