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A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy

Background and objectives: For hormone-sensitive breast cancers, treatment with breast-conserving surgery, tamoxifen, or aromatase inhibitors, along with adjuvant radiation, is the mainstay of therapy. The ideal timing of hormonal and radiation treatment is not well defined, and there is a significa...

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Autores principales: Cecchini, Matthew J, Yu, Edward, Yaremko, Brian P, Boldt, R Gabriel, Potvin, Kylea, Sexton, Tracy, D'Souza, David, Brackstone, Muriel, Lock, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858442/
https://www.ncbi.nlm.nih.gov/pubmed/27182469
http://dx.doi.org/10.7759/cureus.555
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author Cecchini, Matthew J
Yu, Edward
Yaremko, Brian P
Boldt, R Gabriel
Potvin, Kylea
Sexton, Tracy
D'Souza, David
Brackstone, Muriel
Lock, Michael
author_facet Cecchini, Matthew J
Yu, Edward
Yaremko, Brian P
Boldt, R Gabriel
Potvin, Kylea
Sexton, Tracy
D'Souza, David
Brackstone, Muriel
Lock, Michael
author_sort Cecchini, Matthew J
collection PubMed
description Background and objectives: For hormone-sensitive breast cancers, treatment with breast-conserving surgery, tamoxifen, or aromatase inhibitors, along with adjuvant radiation, is the mainstay of therapy. The ideal timing of hormonal and radiation treatment is not well defined, and there is a significant degree of practice variability between concurrent and sequential treatment regimes. This variability can cause confusion amongst the clinical team resulting in contradictory recommendations, loss of patient trust, and the potential for missed initiation of hormonal therapy. Methods: To address this question, a systematic review of the literature was conducted and presented to the breast cancer multidisciplinary team at the London Regional Cancer Center. A three-round modified Delphi method was used to obtain a consensus on a series of a priori determined statements. Results: With the currently available evidence, the consensus was that hormonal therapy should be given sequentially after radiation. This will limit potential overlapping adverse effects between hormonal therapy and radiation that may decrease completion of treatment. The sequential approach has not been associated with any harm in clinical outcomes, and there is some suggestion of increased toxicity with concurrent use. However, in patients at high risk of distant recurrence, they felt it would be reasonable to consider concurrent treatment to avoid any delay in therapy. Conclusion: The consensus of our institution to utilize a sequential approach will standardize the treatment decisions and reduce the risk of failing to initiate hormonal therapy. Despite the lack of level 1 evidence, the Delphi methodology did provide a high level of confidence for our group to choose the sequential approach. The consensus was developed after a review of the literature revealed that there was no clear superiority of one schedule over the other and evidence that concurrent treatment may increase adverse events.
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spelling pubmed-48584422016-05-13 A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy Cecchini, Matthew J Yu, Edward Yaremko, Brian P Boldt, R Gabriel Potvin, Kylea Sexton, Tracy D'Souza, David Brackstone, Muriel Lock, Michael Cureus Radiation Oncology Background and objectives: For hormone-sensitive breast cancers, treatment with breast-conserving surgery, tamoxifen, or aromatase inhibitors, along with adjuvant radiation, is the mainstay of therapy. The ideal timing of hormonal and radiation treatment is not well defined, and there is a significant degree of practice variability between concurrent and sequential treatment regimes. This variability can cause confusion amongst the clinical team resulting in contradictory recommendations, loss of patient trust, and the potential for missed initiation of hormonal therapy. Methods: To address this question, a systematic review of the literature was conducted and presented to the breast cancer multidisciplinary team at the London Regional Cancer Center. A three-round modified Delphi method was used to obtain a consensus on a series of a priori determined statements. Results: With the currently available evidence, the consensus was that hormonal therapy should be given sequentially after radiation. This will limit potential overlapping adverse effects between hormonal therapy and radiation that may decrease completion of treatment. The sequential approach has not been associated with any harm in clinical outcomes, and there is some suggestion of increased toxicity with concurrent use. However, in patients at high risk of distant recurrence, they felt it would be reasonable to consider concurrent treatment to avoid any delay in therapy. Conclusion: The consensus of our institution to utilize a sequential approach will standardize the treatment decisions and reduce the risk of failing to initiate hormonal therapy. Despite the lack of level 1 evidence, the Delphi methodology did provide a high level of confidence for our group to choose the sequential approach. The consensus was developed after a review of the literature revealed that there was no clear superiority of one schedule over the other and evidence that concurrent treatment may increase adverse events. Cureus 2016-04-03 /pmc/articles/PMC4858442/ /pubmed/27182469 http://dx.doi.org/10.7759/cureus.555 Text en Copyright © 2016, Cecchini et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiation Oncology
Cecchini, Matthew J
Yu, Edward
Yaremko, Brian P
Boldt, R Gabriel
Potvin, Kylea
Sexton, Tracy
D'Souza, David
Brackstone, Muriel
Lock, Michael
A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy
title A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy
title_full A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy
title_fullStr A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy
title_full_unstemmed A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy
title_short A Single Institution Consensus on the Use of Sequential or Concurrent Hormonal Therapy for Breast Cancer Patients Receiving Radiation Therapy
title_sort single institution consensus on the use of sequential or concurrent hormonal therapy for breast cancer patients receiving radiation therapy
topic Radiation Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858442/
https://www.ncbi.nlm.nih.gov/pubmed/27182469
http://dx.doi.org/10.7759/cureus.555
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