Trial reportRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology2020
Synchronous versus sequential chemo-radiotherapy in patients with early stage breast cancer (SECRAB): A randomised, phase III, trial.
Trial report in Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00003893 (Sequencing of Chemotherapy and Radiotherapy in Adjuvant Breast Cancer), which is not on this map. Cited by 10 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Sequencing of Chemotherapy and Radiotherapy in Adjuvant Breast Cancer
Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- 6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7).Breast (Edinburgh, Scotland) · 2024Guideline
- Post-neoadjuvant treatment with capecitabine and trastuzumab emtansine in breast cancer patients-sequentially, or better simultaneously?Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2021Pooled it
- Detailed Sub-study Analysis of the SECRAB Trial: Quality of Life, Cosmesis and Chemotherapy Dose Intensity.Clinical oncology (Royal College of Radiologists (Great Britain)) · 2023Trial
- Potential benefits of local radiotherapy in addition to adjuvant chemotherapy in female patients with triple-negative breast cancer in the absence of distant metastases: a SEER database analysis.Translational cancer research · 2026Article
- Chemotherapy Before Radiotherapy in Adjuvant Breast Cancer: The Origins of a Convention and the Case for Revisiting Sequence in the Era of Hypofractionation.Medical sciences (Basel, Switzerland) · 2026Review
- Article
- Flourish of Proton and Carbon Ion Radiotherapy in China.Frontiers in oncology · 2022Review
- Integrating Adjuvant Radiation with Post-Neoadjuvant Therapies in Early Breast Cancer.Current oncology reports · 2021Review
- Neoadjuvant Treatment Options in Soft Tissue Sarcomas.Cancers · 2020Review
- Retrospective Analysis: Preserving More Subcutaneous Tissue Shows no Increase the Risk of Breast Cancer Recurrence.Technology in cancer research & treatmentObservational
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Authors and funding
21 authors.
Funding
Abstract
backgroundThe optimal sequence of adjuvant chemotherapy and radiotherapy for breast cancer is unknown. SECRAB assesses whether local control can be improved without increased toxicity.
methodsSECRAB was a prospective, open-label, multi-centre, phase III trial comparing synchronous to sequential chemo-radiotherapy, conducted in 48 UK centres. Patients with invasive, early stage breast cancer were eligible. Randomisation (performed using random permuted block assignment) was stratified by centre, axillary surgery, chemotherapy, and radiotherapy boost. Permitted chemotherapy regimens included CMF and anthracycline-CMF. Synchronous radiotherapy was administered between cycles two and three for CMF or five and six for anthracycline-CMF. Sequential radiotherapy was delivered on chemotherapy completion. Radiotherapy schedules included 40 Gy/15F over three weeks, and 50 Gy/25F over five weeks. The primary outcome was local recurrence at five and ten years, defined as time to local recurrence, and analysed by intention to treat. ClinicalTrials.gov NCT00003893.
findingsBetween 02-July-1998 and 25-March-2004, 2297 patients were recruited (1150 synchronous and 1146 sequential). Baseline characteristics were balanced. With 10.2 years median follow-up, the ten-year local recurrence rates were 4.6% and 7.1% in the synchronous and sequential arms respectively (hazard ratio (HR) 0.62; 95% confidence interval (CI): 0.43-0.90; p = 0.012). In a planned sub-group analysis of anthracycline-CMF, the ten-year local recurrence rates difference were 3.5% versus 6.7% respectively (HR 0.48 95% CI: 0.26-0.88; p = 0.018). There was no significant difference in overall or disease-free survival. 24% of patients on the synchronous arm suffered moderate/severe acute skin reactions compared to 15% on the sequential arm (p < 0.0001). There were no significant differences in late adverse effects apart from telangiectasia (p = 0.03).
interpretationSynchronous chemo-radiotherapy significantly improved local recurrence rates. This was delivered with an acceptable increase in acute toxicity. The greatest benefit of synchronous chemo-radiation was in patients treated with anthracycline-CMF.
fundingCancer Research UK (CR UK/98/001) and Pharmacia.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.