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Breast cancer patients treated with taxane-based chemotherapies and radiation are not at increased risk of developing a dangerous lung condition known as pneumonitis, according to a study published in the November 17 issue of the Journal of the National Cancer Institute.
Pneumonitis involves inflammation of lung tissue. Study author Thomas Buchholz, M.D., said the results are important because both radiation and taxanes-based chemotherapies, including Taxotere and Taxol, have proven effective in the treatment and improved survival of selected patients with breast cancer.
Buchholz, a professor at the University of Texas M. D. Anderson Cancer Center, said the findings disprove a previous smaller study that had suggested the dangerous correlation between taxanes, radiation treatment and lung injury.
“With this study, we wanted to try and determine if we could alleviate the fears of both the physicians administering and the patients receiving these potentially life-saving treatments," Buchholz said. "We had the unique opportunity to investigate and clearly focus on the question of whether or not taxanes increase radiation induced lung complications. Both taxanes and radiation therapy are critically important in the treatment of patients whose disease has spread beyond the breast.”
The researchers analyzed 189 breast cancer patients who received either four cycles of paclitaxel (Taxol) followed by four cycles of 5-flourouracil, doxorubicin and clyclophsphamide (FAC) and then radiation therapy or eight cycles of FAC followed by radiation.
After reviewing chest X-rays of the women in both groups, the researchers found no statistical difference in the rate of radiation-induced lung toxicity between the two groups of patients; 5 percent in those treated with the paclitaxel-FAC and radiation, compared with 4.5 percent in those treated with FAC and radiation. In addition, the researchers reported that no patients were hospitalized and/or died as a result of pneumonitis.
"Fortunately, we discovered that the rates of seriously related lung injury were very, very low in both groups of patients, making us more comfortable in using these potentially curative treatments without any reservations," said Buchholz.
A key difference between this study and the earlier one that suggested the lung damage correlation was that chemotherapy and radiation were given sequentially, compared to simultaneous delivery in the smaller study.
"It is possible that taxanes and radiation given simultaneously interact to cause increased lung toxicity, but with our delivery, which is more standard practice, we did not see any clinically-relevant damage," said lead researcher Tse-Kuan Yu, M.D., a resident in radiation oncology at M. D. Anderson.
"Additionally, the sequencing and extended time between the delivery of paclitaxel and the radiation might be of great importance,” Yu added. “In our study, four cycles of paclitaxel and then four cycles of FAC were given, followed by surgery and then radiation. Having the buffer window between the Taxol and the radiation might be, in part, cause for why we did not see any lung injury."
Source: Medical Week staff, week of Novmeber 20, 2004
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