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Current Oncology
Volume 31
Issue 8
10.3390/curroncol31080338
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Article

A Randomized Trial Comparing Concurrent versus Sequential Radiation and Endocrine Therapy in Early-Stage, Hormone-Responsive Breast Cancer

by
Sharon F. McGee
1,2,*,
Mark Clemons
1,2,
Gregory Pond
3,
Jean-Michel Caudrelier
1,
Michelle Liu
2,
Mashari Jemaan Alzahrani
1,
Terry L. Ng
1,2,
Arif A. Awan
1,2,
Sandeep Sehdev
1,
John Hilton
1,2,
Marie-France Savard
1,2,
Lesley Fallowfield
4,
Vikaash Kumar
5,
Orit Freedman
6,
Lisa Vandermeer
2,
Brian Hutton
2 and
Jean-Marc Bourque
1,7
1
Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada
2
Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
3
Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
4
SHORE-C, Brighton & Sussex Medical School, University of Sussex, Brighton BN1 9RH, UK
5
Markham Stouffville Hospital, Markham, ON L3P 7P3, Canada
6
Lakeridge Health, Oshawa, ON L1G 8A2, Canada
7
Centre Hospitalier de l’Universite de Montréal (CHUM), Montreal, QC H2X 0A9, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2024, 31(8), 4531-4545; https://doi.org/10.3390/curroncol31080338
Submission received: 10 June 2024 / Revised: 16 July 2024 / Accepted: 26 July 2024 / Published: 7 August 2024
(This article belongs to the Section Breast Cancer)
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Abstract

Concerns exist regarding increased toxicities, including endocrine therapy toxicity, with concurrent radiation and endocrine therapy in early breast cancer (EBC). We present a pragmatic, randomized trial comparing concurrent versus sequential endocrine and radiotherapy in hormone-responsive EBC. In this multicenter trial, patients were randomized to receive adjuvant endocrine therapy concurrent with, or sequential to, radiotherapy. The primary outcome was change in endocrine therapy toxicity from baseline to 3 months post radiotherapy using the Functional Assessment of Cancer Therapy–Endocrine Symptom (FACT-ES) score. From September 2019 to January 2021, 133 patients were randomized to concurrent endocrine and radiotherapy, and 127 to sequential treatment. Most patients were post-menopausal (72.7%, 189/260) with stage 1 disease (65.8%, 171/260). Tamoxifen was the endocrine therapy of choice for 69.6% (181/260) of patients, and an aromatase inhibitor for the remainder. The median total radiation dose and fractions were 40.1 Gray (range 26–50) and 15 fractions (range 5–25), respectively. For the primary outcome of change in endocrine therapy toxicity per FACT-ES scores from baseline to 3 months post radiotherapy, no significant difference was found between the groups (median [range] = −4.9 (−82, 38.8) for concurrent and −5.1 (−42, 40) for sequential, p = 0.87). This is the first trial to investigate the impact of concurrent versus sequential adjuvant endocrine and radiotherapy on endocrine therapy-related toxicities. The findings provide further support to allow the optimal timing of radiation and endocrine therapy to be tailored for the individual patient.
Keywords: breast cancer; endocrine therapy; radiotherapy; treatment sequence; toxicity; quality of life breast cancer; endocrine therapy; radiotherapy; treatment sequence; toxicity; quality of life

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MDPI and ACS Style

McGee, S.F.; Clemons, M.; Pond, G.; Caudrelier, J.-M.; Liu, M.; Alzahrani, M.J.; Ng, T.L.; Awan, A.A.; Sehdev, S.; Hilton, J.; et al. A Randomized Trial Comparing Concurrent versus Sequential Radiation and Endocrine Therapy in Early-Stage, Hormone-Responsive Breast Cancer. Curr. Oncol. 2024, 31, 4531-4545. https://doi.org/10.3390/curroncol31080338

AMA Style

McGee SF, Clemons M, Pond G, Caudrelier J-M, Liu M, Alzahrani MJ, Ng TL, Awan AA, Sehdev S, Hilton J, et al. A Randomized Trial Comparing Concurrent versus Sequential Radiation and Endocrine Therapy in Early-Stage, Hormone-Responsive Breast Cancer. Current Oncology. 2024; 31(8):4531-4545. https://doi.org/10.3390/curroncol31080338

Chicago/Turabian Style

McGee, Sharon F., Mark Clemons, Gregory Pond, Jean-Michel Caudrelier, Michelle Liu, Mashari Jemaan Alzahrani, Terry L. Ng, Arif A. Awan, Sandeep Sehdev, John Hilton, and et al. 2024. "A Randomized Trial Comparing Concurrent versus Sequential Radiation and Endocrine Therapy in Early-Stage, Hormone-Responsive Breast Cancer" Current Oncology 31, no. 8: 4531-4545. https://doi.org/10.3390/curroncol31080338

APA Style

McGee, S. F., Clemons, M., Pond, G., Caudrelier, J.-M., Liu, M., Alzahrani, M. J., Ng, T. L., Awan, A. A., Sehdev, S., Hilton, J., Savard, M.-F., Fallowfield, L., Kumar, V., Freedman, O., Vandermeer, L., Hutton, B., & Bourque, J.-M. (2024). A Randomized Trial Comparing Concurrent versus Sequential Radiation and Endocrine Therapy in Early-Stage, Hormone-Responsive Breast Cancer. Current Oncology, 31(8), 4531-4545. https://doi.org/10.3390/curroncol31080338

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