Dr Alphonse Taghian, Department of Radiation Oncology, Massachusetts General Hospital, Boston, and colleagues conducted a retrospective cohort study involving 41 patients with breast cancer. All patients were treated with combination chemotherapy including paclitaxel, and radiotherapy, either concurrently or sequentially. The investigators compared the incidence of radiation pneumonitis in these patients with that among patients on their database who had not received paclitaxel as part of their chemotherapy regimen. They found that 14.6 per cent of patients who had received paclitaxel developed radiation pneumonitis compared with only 1.1 per cent of patients who had not received the drug (P<0.0001).

The authors conclude that the use of paclitaxel and radiation therapy in the primary treatment of breast cancer should be undertaken with caution. Commenting on the trial, Dr Taghian said that the success rate for treatment of pneumonitis was almost 100 per cent and that this complication should not make patients refuse paclitaxel. "It can be delivered safely in combination with radiation, but we need to use extra caution in the placement of the radiation beams," he added.

The study is published in the Journal of the National Cancer Institute (2001;93:1806).