Efficacy and Safety of Concurrent Chemoradiotherapy with Docetaxel for Locally Advanced Breast Carcinoma after Modified Radical Mastectomy


Breast cancer
Concurrent chemoradiotherapy
Modified radical mastectomy


How to Cite

Wang, J., Wei, C., Liu, W. ., Wang, B., & Han, Q. (2022). Efficacy and Safety of Concurrent Chemoradiotherapy with Docetaxel for Locally Advanced Breast Carcinoma after Modified Radical Mastectomy. Iranian Red Crescent Medical Journal, 24(7). https://doi.org/10.32592/ircmj.2022.24.7.1992


Background: Breast cancer is a common term for a malignant tumor that arises from the epithelial component of the breast. Concurrent chemoradiotherapy’s efficacy and safety are controversial, considering the impact on patients' quality of life.

Objectives: The aim of this study was investigating the efficacy and safety of concurrent chemoradiotherapy with docetaxel in locally advanced breast cancer who have received a modified radical mastectomy.

Methods: A cohort of 110 female patients with locally advanced breast cancer were included in the present study and divided by chemoradiotherapy mode into a concurrent chemoradiotherapy group (n=58) and a sequential chemoradiotherapy group (n=52). Docetaxel was administered concurrently during radiotherapy in the concurrent group, whereas the sequential group underwent adjuvant radiotherapy 1-3 weeks after chemotherapy. Then, the two groups were compared with respect to clinical efficacy, levels of tumor markers across vascular endothelial growth factor (VEGF) and Carcinoembryonic antigen (CEA), adverse reactions, and the 3-year overall survival (OS) rate.

Results: The results showed that the mean age, operation, evaluation of Post treatment VEGF (pg / mg) and Post treatment CEA (/g / L), effectiveness of treatment in two sequential and concurrent treatment groups was not significant The results showed that the amount of Prior treatment VGEF (pg / mg) and Post treatment VGEF (pg / mg) in the two groups were statistically significant difference. Which shows the positive effect of this treatment before and after the intervention. Comparison of survival time in the two groups did not show a significant difference.

Conclusion: The chemotherapy protocol with a combination of cyclophosphamide, fluorouracil and epirubicin with concurrent docetaxel presented higher efficacy and prolonged the overall survival in locally advanced breast cancer patients who had undergone a radical mastectomy, while it did not significantly increase the toxicity.



Zhang X, Ju S, Wang X, Cong H. Advances in liquid biopsy using circulating tumor cells and circulating cell-free tumor DNA for detection and monitoring of breast cancer. Clin Exp Med. 2019;19(3):271-9. doi: 10.1007/s10238-019-00563-w. [PubMed: 31190187]

Sambyal V, Guleria K, Kapahi M, Manjari M, Sudan M, Uppal MS, et al. Association of VEGF haplotypes with breast cancer risk in North-West Indians. BMC Med Genomics. 2021;14(1):1-9. doi: 10.1186/s12920-021-01060-4. [PubMed: 34429108]

Adams J, Carder PJ, Downey S, Forbes MA, MacLennan K, Allgar V, et al. Vascular endothelial growth factor (VEGF) in breast cancer: comparison of plasma, serum, and tissue VEGF and microvessel density and effects of tamoxifen. Cancer Res. 2000;60(11):2898-905. [PubMed: 10850435]

Zheng C, Yu ZG. Clinical practice guidelines for pre-operative evaluation of breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021. Chin Med J (Engl). 2021;134(18):2147-9. doi: 10.1097/CM9.0000000000001520. [PubMed: 34039864]

Ditsch N, Untch M, Kolberg Liedtke C, Jackisch C, Krug D, Friedrich M, et al. AGO recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer: update 2020. Breast Care. 2020;15(3):294-309. doi: 10.1159/000508736. [PubMed: 32774225]

Kawaguchi R, Furukawa N, Kobayashi H, Asakawa L. Posttreatment cut-off levels of squamous cell carcinoma antigen as a prognostic factor in patients with locally advanced cervical cancer treated with radiotherapy. J Gynecol Oncol. 2013;24(4):313-20. doi: 10.3802/jgo.2013.24.4.313. [PubMed: 24167666]

Zheng R, Han S, Duan C, Chen K, You Z, Jia J, et al. Role of

taxane and anthracycline combination regimens in the management of advanced breast cancer: a meta-analysis

of randomized trials. Medicine. 2015;94(17):1-10. doi: 10.1097/MD.0000000000000803. [PubMed: 25929935]

Ferrari D, Ghi MG, Franzese C, Codeca C, Gau M, Fayette J. The slippery role of induction chemotherapy in head and neck cancer: myth and reality. Front Oncol. 2020;10:1-12. doi: 10.3389/fonc.2020.00007. [PubMed: 32038985]

Society of gastric cancer of china anti-cancer. CACA guidelines for holistic integrative management of gastric cancer. Holistic Integrative Oncology. 2022;1(1):1-45. doi: 10.1007/s44178-022-00004-x.

Armato SG 3rd, Nowak AK. Revised modified response evaluation criteria in solid tumors for assessment of response in malignant pleural mesothelioma (Version 1.1). J Thorac Oncol. 2018;13(7):1012-21. doi: 10.1016/j.jtho.2018.04.034. [PubMed: 29753121]

Cox JD, Stetz J, Pajak TF, Toxicity criteria of the radiation therapy oncology group (RTOG) and the european organization for research and treatment of cancer (EORTC).

Int J Radiat Oncol Biol Phys. 1995;31(5):1341-6. doi: 10.1016/0360-3016(95)00060-C. [PubMed: 7713792]

Brackstone M, Palma D, Tuck AB, Scott L, Potvin K, Vandenberg T, et al. Concurrent neoadjuvant chemotherapy and radiation therapy in locally advanced breast cancer. Int J Radiat Oncol Biol Phys. 2017;99(4):769-76. doi: 10.1016/j.ijrobp.2017.06.005. [PubMed: 28870785]

Li L, Yang Y, Li W, Zhao X, He J, Mei S, et al. Latissimus dorsi myocutaneous flap repair is effective after neoadjuvant chemotherapy for locally advanced breast cancer. World J Surg Oncol. 2022;20(1):1-10. doi: 10.1186/s12957-022-02598-y. [PubMed: 35477520]

Zhao H, Zhang J, Lu Y, Jin J. Neoadjuvant chemotherapy in combination with surgery in the treatment of local advanced breast cancer. Pak J Med Sci. 2019;35(5):1402-7. doi: 10.12669/pjms.35.5.310. [PubMed: 31489015]

McCarthy N, Boyle F, Bull J, Leong E, Simpson A, Kannourakis G, et al. Neoadjuvant chemotherapy with sequential anthracycline-docetaxel with gemcitabine for large operable or locally advanced breast cancer: ANZ 0502 (NeoGem). Breast. 2014;23(2):142-51. doi: 10.1016/j.breast.2013.12.001. [PubMed: 24393617]

Lu Y, Huang H, Yang H, Chen D. Randomized controlled trial of late-course concurrent versus sequential chemoradiotherapy after mastectomy and axillary surgery in locally advanced breast cancer. Medicine (Baltimore). 2017;96(41):1-6. doi: 10.1097/MD.0000000000008252. [PubMed: 29019894]

Daryiush M, Gholizadeh Pasha A, Hajjan K, Sum SH, Pourghasem M, Jahantigh R. Comparison of modified radical mastectomy with breast conservative therapy and radiotherapy in patients with breast cancer. J Babol Univ Medical Sci. 2012;14(5):36-41.

Nirhale DS, Sooraj R, Rawat A. Role of neoadjuvant chemotherapy in downstaging locally advanced breast carcinoma, selection of surgical procedure and its outcome. Int Surg. 2020;7(2):526. doi: 10.18203/2349-2902.isj20200309

Tuxen MK, Cold S, Tange UB, Balslev E, Nielsen DL. Phase II study of neoadjuvant pegylated liposomal doxorubicin and cyclophosphamide ± trastuzumab followed by docetaxel in locally advanced breast cancer. Acta Oncol. 2014;53(10):1440-5. doi: 10.3109/0284186X.2014.921727. Epub 2014 Jul 3. [PubMed: 24991893]

Montagna E, Bagnardi V, Rotmensz N, Viale G, Pruneri G, Veronesi P, et al. Pathological complete response after preoperative systemic therapy and outcome: relevance of clinical and biologic baseline features. Breast Cancer Res Treat. 2010;124(3):689-99. doi: 10.1007/s10549-010-1027-4. [PubMed: 20625816]

Won HS, Kim YS, Kim JS, Chang ED, Na SJ, Whang IY, et al. Clinical outcome and predictive factors for docetaxel and epirubicin neoadjuvant chemotherapy of locally advanced breast cancer. Korean J Intern Med. 2020;35(6):1489-96. doi: 10.3904/kjim.2019.031. [PubMed: 32069523]

Wildiers H, Neven P, Christiaens MR, Squifflet P, Amant F, Weltens C, et al. Neoadjuvant capecitabine and docetaxel (plus trastuzumab): an effective non-anthracycline-based chemotherapy regimen for patients with locally advanced breast cancer. Ann Oncol. 2011;22(3):588-94. doi: 10.1093/annonc/mdq406. [PubMed: 20709813]

Sadeghi M, Hojati Z, Ghaedi K, To assay the relation between the vascular endothelial growth factor expression and breast cancer tumor formation. J Arak Uni Med Sci. 2014;17(8):27-34.

Saravani R, Sargazi S, Rabbani M, Saravani R. Evaluation of VEGF gene expression levels and induction of apoptosis

in crocin-treated MCF-7 breast cancer cells. JSSU. 2019;26(10):845-56. doi: 10.18502/ssu.v26i10.474.

Molina R, Auge JM, Farrus B, Zanon G, Pahisa J, Munoz M, et al. Prospective evaluation of carcinoembryonic antigen (CEA) and carbohydrate antigen 15.3 (CA 15.3) in patients with primary locoregional breast cancer. Clin Chem. 2010;56(7):1148-57. doi: 10.1373/clinchem.2009.135566. Epub 2010 May 14. [PubMed: 20472825]

Svobodova S, Kucera R, Fiala O, Karlikova M, Narsanska A, Zednikova I, et al. CEA, CA 15-3, and TPS as prognostic factors in the follow-up monitoring of patients after radical surgery for breast cancer. Anticancer Res. 2018;38(1):465-9. doi: 10.21873/anticanres.12245. [PubMed: 29277810]

Carrara GFA, Scapulatempo Neto C, Abrahao Machado LF, Brentani MM, Nunes JS, Folgueira MA, et al. Breast-conserving surgery in locally advanced breast cancer submitted to neoadjuvant chemotherapy. Safety and effectiveness

based on ipsilateral breast tumor recurrence and long-term follow-up. Clinics (Sao Paulo). 2017;72(3):134-42. doi: 10.6061/clinics/2017(03)02. [PubMed: 28355358]

Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717-30. doi: 10.1245/s10434-014-3480-5. Epub 2014 Jan 29. [PubMed: 24473640]