Plasma levels of VEGF-A, VEGF B, and VEGFR-1 and applicability of these parameters as tumor markers in diagnosis of breast cancer

The VEGF family members are important factors in promoting angiogenesis and lymphangiogenesis in malignant processes. The aim of this study was to investigate plasma concentrations of VEGF-A, VEGF-B and their soluble VEGFR-1 receptor and their diagnostic utility and potency as compared to CA 15-3 in breast cancer patients and in relation to the control group. The study included 120 breast cancer patients and 60 control patients. Plasma levels of tested parameters were determined with ELISA and CA 15-3 levels were determined with CMIA. Concentrations of all tested parameters in breast cancer patients showed statistically significant difference when compared to the control groups (benign breast tumor patients and/or healthy women). VEGF-B showed the highest values of sensitivity (Sn) and predictive value of a negative test result (NPV) in total BC group (90% and 66.7%, respectively) and, more importantly, in stages I–II of BC (SE: 86.8%; 92.7%, NPV: 82.8%; 88.9%, respectively). Among all parameters tested, VEGF-A showed the highest specificity (Sf) (76.7%) and predictive value of a positive test result (PPV) (84.8%), yet they were lower than for CA 15-3. VEGF-A was also the best parameter that had statistically significant Area Under Curve (AUC) in stages I (0.678) and II (0.768). In the whole group of BC patients all parameters tested showed statistically significant AUC, but the maximum range was obtained for the combination of VEGF-A and CA 15-3 (0.817). The combined analysis of the studied parameters and CA 15-3 resulted in an increase in sensitivity and AUC values, which provides hope for developing a new panel of biomarkers that may be used in BC diagnosis in the future.

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Exploring The Clinical Significance of Serum Angiopoietin-2 In Breast Cancer Patients

QJM ◽

10.1093/qjmed/hcab091.014 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Abeer I Abd Elmagid ◽

Hala Abdel Al ◽

Wessam El Sayed Saad ◽

Seham Kamal Mohamed

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Serum Levels ◽

Tnm Staging ◽

Control Group ◽

Healthy Controls ◽

Breast Cancer Patients ◽

Female Patients ◽

Significant Difference ◽

Angiopoietin 2

Abstract Background Breast cancer is the most common cancer among women and one of the most important causes of death among them.Angiogenesis is an important step for primary tumor growth, invasiveness, and metastases. Angiopoietins are well-recognized endothelial growth factors that are involved in angiogenesis associated with tumors. Aim To explore the diagnostic significance of serum angiopoietin-2 (Ang-2) in breast cancer and to evaluate its prognostic efficacy through studying the degree of its association with the TNM staging of the disease. Patients and Methods This study was conducted on (35) Egyptian female patients who were diagnosed as breast cancer according to histopathological examination of breast biopsy (Group 1, Breast Cancer Patients) and (25) female patients with benign breast diseases (Group II, Pathological Control Patients), in addition to (20) age - matched apparently healthy, free mammogram, females serving as healthy controls (Group III, Healthy Controls). For all participants, measurement of serum Ang-2 was done using enzyme linked immunosorbent assay (ELISA) technique. Results A highly significant increased levels of Ang-2 was observed in breast cancer patients when compared to healthy control group (Z = 4.95, p < 0.01). However, no significant difference was observed in Ang-2 levels between breast cancer patients group and pathological control group (Z = 3.37, p > 0.05). No significant difference was detected in Ang-2 levels in relation to TNM stage and histological grade. No significant correlation was found between Ang-2 levels and serum levels of CA15-3, hormone receptors, HER2/new receptor status (p > 0.05, respectively). Conclusion This study revealed that Ang-2 serum levels were significantly increased in patient with breast cancer compared with healthy controls, indicating that high Ang-2 level is a promising non invasive biomarker for breast cancer diagnosis. However, no significant difference of Ang-2 levels was detected in relation of breast TNM staging in the population studied.

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Effect of Flavor Enhancement on the Appreciation of Food in Breast Cancer Patients Undergoing Chemotherapy

Current Developments in Nutrition ◽

10.1093/cdn/nzaa044_019 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 320-320

Author(s):

Kenza Drareni ◽

Moustafa Bensafi ◽

Helene Lusson ◽

Damien Vansteene ◽

Agnès Giboreau ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Hierarchical Cluster ◽

Cross Sectional Study ◽

Control Group ◽

Breast Cancer Patients ◽

Cross Sectional ◽

Funding Sources ◽

Significant Difference ◽

The Impact

Abstract Objectives Given the influence of sensory signals on food intake regulation and the subsequent nutritional status, it is important to reduce the impact of commonly observed smell and taste alterations on the pleasure of eating during chemotherapy. This study aimed to examine the effect of various types of flavor enhancement on the appreciation of an appetizer by a group of patients undergoing chemotherapy. Methods Five eggplant appetizers with no seasoning (REF) or enhanced with either salt, lemon, garlic or cumin were developed. In this cross-sectional study, 36 healthy female subjects (age 58 ± 7 y) (control group) and 84 breast cancer patients (age 56 ± 11 y) treated with chemotherapy were recruited. A hierarchical cluster analysis based on patients' self-reported smell and taste abilities classified the patients in two groups: the ‘unaltered, (high sensory abilities) n = 49’ and the ‘altered, (poor sensory abilities), n = 35’ group. Participants tasted and assessed the appreciation of the reference appetizer on a visual analog scale and performed a randomized comparative liking task, by rating the appreciation for each flavor-enhanced appetizer relative to the REF (one-sample t-test). Results There was no significant difference in the appreciation of the REF appetizer between the three groups (P > 0.05). In the comparative liking task, the control group rated similarly the appreciation between the flavor-enhanced and the REF appetizers except for the cumin-enhanced appetizer, which was appreciated significantly more than the REF (P < 0.001). Patients in both ‘altered’ and ‘unaltered’ groups appreciated similarly the cumin appetizer (P > 0.05), more the salt and garlic-enhanced appetizers (P ≤ 0.001, P = 0.005, respectively) and significantly less the lemon-enhanced appetizer relative to the REF (P = 0.029), confirming a tendency for patients to reject acid-flavored foods. Conclusions The salt and garlic enhancements were appreciated by the patients independent of the stage of chemotherapy or the severity of smell and taste alterations. Flavor enhancement seems a good strategy to maintain the pleasure of eating in patients undergoing chemotherapy. Further research is still needed on the appreciation and intake of a complete meal (starter, main course, dessert). Funding Sources APICIL and ELIOR groups.

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Intelligent Optimization of Treatment of Acupuncture based on Modern Data Analysis (Preprint)

10.2196/preprints.18572 ◽

2020 ◽

Author(s):

Xiujun Wang

Keyword(s):

Breast Cancer ◽

Data Analysis ◽

Acupuncture Therapy ◽

Cancer Patients ◽

Postoperative Treatment ◽

Major Surgery ◽

Control Group ◽

Breast Cancer Patients ◽

Significant Difference ◽

Experimental Group

BACKGROUND Background: Postoperative Fatigue Syndrome (POFS) occurs in almost every patient who has undergone major surgery. With the ever-increasing attention of people on rehabilitation treatment, POFS has received unprecedented attention. OBJECTIVE Objective: Based on modern data analysis, acupuncture treatment is optimized intelligently, and its efficacy in breast cancer patients with POFS is explored. METHODS Methods: In this study, the acupuncture and moxibustion in traditional Chinese medicine were combined to optimize the formation of warm acupuncture therapy, and then the research on warm acupuncture was optimized using modern data analysis methods. At first, the statistics of personal information and operation of 60 patients with breast cancer was carried out. The statistical results were analyzed by rank sum test and independent sample T test. The Visual Analogue Scale (VAS), Brief Profile Of Mood State (BPOMS), and Identity-Consequence Fatigue Scale (ICFS) were utilized to analyze the fatigue degree, mental state, and fatigue state of the patients. RESULTS Results: There was no significant difference in age (U = 473.34, P = 0.583) and education level (U = 479.20, P = 0.613) between the experimental group and the control group (P > 0.05), which were comparable. Compared with the control group, the VAS values of the experimental group on the 3rd day (P = 043), 7th day (P = 0.039), and 14th day (P = 0.030) of postoperative treatment were significantly reduced, with significant differences (P < 0.05). In the experimental group, the BPOMS values on the 3rd day (P = 0.042), 7th day (P = 0.035), and 14th day (P = 0.031) of postoperative treatment were significantly reduced, with significant differences (P < 0.05). The ICFS values of the experimental group on the 3rd day (P = 046), 7th day (P = 0.037), and 14th day (P = 0.031) of postoperative treatment were significantly reduced, with significant differences (P < 0.05). The variance of transferrin levels was uniform on the 7th day after operation (F = 0.679, P = 0.433 > 0.005), with a significant difference (T = -2.985, P = 0.008 < 0.05). CONCLUSIONS Conclusions: Warm acupuncture therapy could effectively improve the POFS of breast cancer patients, which was a safe and effective treatment. CLINICALTRIAL

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Effectiveness of yoga on anxiety, depression and stress level of breast cancer patients undergoing chemotherapy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175511 ◽

2017 ◽

Vol 6 (1) ◽

pp. 74

Author(s):

Kamli Prakash ◽

Sunil Saini

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Stress Level ◽

Controlled Trial ◽

Control Group ◽

Research Approach ◽

Breast Cancer Patients ◽

Significant Difference ◽

Anxiety Depression ◽

Experimental Group

Background: Breast cancer has ranked number one cancer among Indian females. Women undergoing chemotherapy experience many side effects including alteration in their body image. The present study assessed effectiveness of yoga on anxiety, depression and stress level of breast cancer patients undergoing chemotherapy.Methods: Quantitative Research approach and Randomized Clinical Controlled Trial with Time series design was adopted in the present study. The consecutive sampling technique was done to recruit 100 breast cancer patients fulfilling the eligibility criteria. Recruited patients were randomized to control (N=52) and experiment (N=48) groups by concealed randomization. Written informed consent was taken from each participant. Baseline data was collected during cycle one by using Anxiety depression and stress scale. The patients in the experimental group were taught Diaphragmatic breathing, systematic relaxation and alternate nostril breathing and Joints and Gland neck and shoulder exercises, and were instructed to practice them twice daily at home. They were supervised in practicing these when they received second, third, fourth, fifth and sixth cycles of chemotherapy. Participants in control group received routine care. Data was again collected after 21 days during second, third, fourth, fifth and sixth cycles of chemotherapy.Results: Analysis revealed that at the baseline breast cancer patients in control and experimental group were homogenous in terms of their Sociodemographic and anxiety depression and stress scores. After the yoga intervention the experimental group showed statistically significant difference in anxiety scores from control group during second, third and sixth cycles (p 0.01, p 0.02, p 0.02), in depression score during the second, third, fourth, fifth and sixth cycles (p 0.02, p 0.02, p 0.02, p 0.001, p 0.000), and in stress scores during third cycle (p 0.01) of chemotherapy.Conclusions: On the basis of findings of the study it was concluded that yoga was effective in reducing the anxiety, depression and stress of breast cancer patients undergoing chemotherapy. Therefore, it is recommended as complementary therapy for patients receiving treatment for cancer.

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The influences of preoperative metformin on immunological factors in early breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e14182 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e14182-e14182

Author(s):

Takahiro Takahiro ◽

Tadahiko Shien ◽

Naruto Taira ◽

Mariko Kochi ◽

Takayuki Iwamoto ◽

...

Keyword(s):

Breast Cancer ◽

Prospective Study ◽

Cancer Patients ◽

Early Breast Cancer ◽

Control Group ◽

Metformin Treatment ◽

Breast Cancer Patients ◽

Significant Difference ◽

Immunological Factors ◽

Risk Of Cancer

e14182 Background: Metformin is one of the most commonly prescribed drugs for type 2 diabetes, and some reports have suggested that metformin may reduce cancer risk. Diabetics treated with metformin have a 23% reduction in the risk of cancer, including breast cancer. In addition, it is reported that the breast cancer patients with metformin treatment for diabetes showed favorable prognosis compared with those without metformin treatment. However, the mechanism underlying the positive effects of metformin on cancer treatment remains unclear. Methods: We conducted a prospective study to evaluate the effect of preoperative metformin on early breast cancer patients. The patients took a daily dose of metformin orally for 7 to 21 days before surgery. We evaluated the effects on immunological factors (TILs, CD4+, CD8+, PD-L1 and ALDH1) by comparing core needle biopsies (CNB) obtained before surgery with surgical specimens. Results: Seventeen breast cancer patients were enrolled in this prospective study and administered metformin before surgery, during the period from January to December 2016. We analyzed 59 patients who received surgery during the same period as a control group. In the control group, there was no significant difference in TILs between CNB and surgical specimens (Rs = 0.63). In the metformin group, TILs were negative in CNB and surgical specimens of 15 (88%) and 8 (48%) cases, low in 2 (12%) and 8 (48%), and intermediate in 0 and 1 (6%), respectively. These TILs increases were confirmed in 5 (29%) patients (p = 0.09), while a decrease was confirmed in 2 (12%). The expressions of CD4+ and CD8+ by TILs were increased in 41% and 18% of surgical specimens, respectively. (p = 0.02, p = 0.09) However, there was no statistically significant difference in these immunological factors and PD-L1 or ALDH1 expression between before and after metformin. Conclusions: In our small cohort, preoperative metformin administration shows positive impact on CD4 positive lymphocytes significantly and has tendency of increasing both TILs and CD8 positive lymphocytes. However, we should keep in mind that our sample size is small. Further study is necessary to uncover the mechanisms of favorable effects of metformin on breast cancer patients.

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Inherited thrombophilic risk factors in Serbian breast cancer patients

Genetika ◽

10.2298/gensr1902463p ◽

2019 ◽

Vol 51 (2) ◽

pp. 463-472

Author(s):

Iva Pruner ◽

Branko Tomic ◽

Marija Dragojevic ◽

Maja Gvozdenov ◽

Mirjana Kovac ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Patients ◽

Cancer Susceptibility ◽

Mthfr C677t ◽

Control Group ◽

Gene Variants ◽

Breast Cancer Patients ◽

Significant Difference

Breast cancer is the leading cause of cancer-related death among women. An increased burden of thrombotic events among breast cancer patients, leading to higher mortality and morbidity rates, is well established. There are a number of genetic risk factors associated with thrombosis, but their contribution to thrombotic tendencies in patients with cancer is not completely elucidated. We aimed to investigate possible role of FV Leiden, FII G20210A, MTHFR C677T and PAI-1 4G/5G gene variants in etiopathology of breast cancer and accompanying thrombosis in cohort of Serbian patients. Our study included 316 subject divided in three groups: breast cancer patients with (97) or without (99) accompanying thrombosis and healthy control group (120). According to our results, the prevalence for all four prothrombotic gene variants were similar in cancer patients with and without thrombosis and no statistically significant difference was observed between these groups. We detected lower frequency of MTHFR 677TT genotype in breast cancer patients when compared to control group (P=0.014; OR=0.145 (95%CI 0.031-0.679)), indicated that MTHFR C677T homozygosity could play a protective role in breast cancer susceptibility. Our study noted the lack of association between common prothrombotic gene variants and increased prothrombotic risk in Serbian breast cancer patients. Also, our results point out possible role of MTHFR 677TT genotype in etiology of breast cancer, but further studies on larger cohort of patients are needed.

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Dextromethorphan phenotyping as a test for prediction of tamoxifen (TAM) activation in breast cancer patients receiving adjuvant hormone therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e13019 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e13019-e13019

Author(s):

Milena Gusella ◽

Laura Bertolaso ◽

Felice Pasini ◽

Yasmina Modena ◽

Antonio Bononi ◽

...

Keyword(s):

Breast Cancer ◽

Steady State ◽

Cancer Patients ◽

Plasma Levels ◽

Linear Regression Analysis ◽

Plasma Concentrations ◽

Breast Cancer Patients ◽

Active Metabolites ◽

Adjuvant Hormone Therapy ◽

State Plasma

e13019 Background: TAM is mainly metabolized by CYP2D6 to form its most active metabolites, 4hydroxy-tamoxifen (4OH-T) and endoxifen (END). Because of its long half-life, steady state is reached after around 4 months of continuous intake. The wide variable inter-patient activity of CYP2D6 might influence drug efficacy. A multi-institutional study in north Italy is evaluating the relationship between END levels and outcome. As a part of it, we investigated the role of dextromethorphan (DM), a probe drug for CYP2D6 enzymatic activity, as a potential phenotyping test for TAM activation. Methods: Twenty-nine breast cancer patients (75% postmenopausal) on adjuvant TAM therapy (20 mg/die) were investigated. They received a single dose (15 mg) of oral DM before starting TAM and their urines were collected over the10 following hours. Simultaneous quantitative determination of DM and its metabolite dextrorphan (DO) was performed in urines to estimate their log transformed metabolic ratio (LMR=logDM/DO). After 4 months a blood sample was collected to characterize TAM exposure at steady state; plasma levels of TAM, END, 4OH-T and the non active END precursor N-desmethyltamoxifen (NDT) were quantified by HPLC. Linear regression analysis and t test were performed for correlating LMR and drug plasma levels. Results: LMR varied between -2.15 and 0.90 (median: -1.37) while steady state plasma levels of END varied between 1.9 and 15.0 ng/ml (median: 4.36) and 4OH-T between 0.9 to 3.1 ng/ml (median:1.72). A significant correlation (r = 0.56; p= 0.0013) was found between LMR and END plasma concentrations. The patients with high LMR (> median value), compared to patients with low LMR, had lower END (3.7 vs 7.5 ng/ml, p=0.0003), lower 4OH-T (1.6 vs 2.1 ng/ml, p=0.04) and, accordingly, higher NDT (291.2 vs 198.2 ng/ml, p=0.025). Conclusions: DM/DO urine ratio obtained before starting therapy correlates with TAM biotransformation activity and can predict steady state active metabolites exposure in individual patients. This phenotyping test is fast, simple and unexpensive and could contribute to the personalization of adjuvant breast cancer treatment. Funded by Regione Veneto.

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Feasibility study of nipple-sparing mastectomy for Japanese breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.166 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 166-166

Author(s):

Maiko Takahashi ◽

Hiromitsu Jinno ◽

Tetsu Hayashida ◽

Yuko Kitagawa

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Cancer Patients ◽

Preoperative Imaging ◽

Control Group ◽

Breast Cancer Patients ◽

Significant Difference ◽

The Mean ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

166 Background: Nipple-sparing mastectomy (NSM) has been gathering increased recognition as an alternative to more traditional mastectomy approaches. However, the oncological safety of these procedures is still to be elucidated. The purpose of this study is to investigate technical feasibility of NSM without increasing the risk of local recurrence and complications. Methods: Ninety-eight stage 0-III breast cancer patients received NSM between January 2001 and April 2012 at Keio University Hospital. Eligible patients were without skin involvement and not indicated for breast-conserving therapy by preoperative imaging. The pathological analysis of the subareolar tissue was performed and nipple-areolar-complex (NAC) would be removed if positive. Four hundred seventy-four breast cancer patients who had mastectomy during the same period were used as a control group. Results: The median age was 46.0 years (range 29–68). The mean clinical tumor size was 2.8±1.2cm and the mean distance between the nipple and the tumor was 2.5±1.7cm. Ninety-one patients (92.9%) had clinically node-negative status. NAC involvement was observed in 3 patients (3.1%). Three patients (3.1%) presented with epidermal necrosis. After a median follow-up period of 37.3 months (range 1-136), there were 7 recurrences (7.1%), including 4 local recurrences (4.1%) and 3 distant metastases (3.1%). There was no statistically significant difference in local recurrence between the patients with NSM and mastectomy (4.1% vs. 3.2%; p=0.16). Immediate and delayed reconstruction was performed in 2 cases (2.0%) and 41 cases (41.8%), respectively. Conclusions: Our results suggested NSM may provide oncologic safety for strongly motivated and carefully selected patients.

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Hydroxytyrosol Supplementation Modifies Plasma Levels of Tissue Inhibitor of Metallopeptidase 1 in Women with Breast Cancer

Antioxidants ◽

10.3390/antiox8090393 ◽

2019 ◽

Vol 8 (9) ◽

pp. 393 ◽

Cited By ~ 5

Author(s):

Cesar Ramirez-Tortosa ◽

Ana Sanchez ◽

Cristina Perez-Ramirez ◽

Jose Luis Quiles ◽

María Robles-Almazan ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Plasma Levels ◽

Adverse Reactions ◽

Virgin Olive Oil ◽

Extra Virgin Olive Oil ◽

Control Group ◽

Breast Cancer Patients ◽

Tissue Inhibitor ◽

Metalloproteinase 9

The etiology of breast cancer can be very different. Most antineoplastic drugs are not selective against tumor cells and also affect normal cells, leading to a wide variety of adverse reactions such as the production of free radicals by altering the redox state of the organisms. Therefore, the objective of this study was to elucidate if hydroxytyrosol (HT) (an antioxidant present in extra virgin olive oil) has a chemomodulatory effect when combined with the chemotherapeutic drugs epirubicin and cyclophosphamide followed by taxanes in breast cancer patients. Changes in plasma levels of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinases 1 (TIMP-1) throughout the chemotherapy treatment were studied. Both molecules are involved in cell proliferation, apoptosis, neoangiogenesis, and metastasis in breast cancer patients. Women with breast cancer were divided into two groups: a group of patients receiving a dietary supplement of HT and a control group of patients receiving placebo. The results showed that the plasma levels of TIMP-1 in the group of patients receiving HT were significantly lower than those levels found in the control group after the epirubicin-cyclophosphamide chemotherapy.

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Trial of concurrent versus sequential tamoxifen with radiotherapy in breast cancer patients with study of the combination of pentoxifylline and tocopherol for prevention of radiation-induced lung fibrosis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e11599 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e11599-e11599 ◽

Cited By ~ 2

Author(s):

Soheir Sayed Ismail ◽

Zeinab Mohamed Abdel-Hafeez ◽

Dalia Abd-Elghany El Khodary ◽

Mohamed rada Kelany

Keyword(s):

Breast Cancer ◽

Pulmonary Fibrosis ◽

Cancer Patients ◽

Lung Fibrosis ◽

Practical Importance ◽

Control Group ◽

Breast Cancer Patients ◽

Significant Difference ◽

Radiation Induced ◽

The Impact

e11599 Background: Although the efficacy of both radiation and tamoxifen (TAM) in early-stage breast cancer is well established, data are lacking about the impact of this sequence on outcomes, including local recurrence and complications of therapy. These are questions of practical importance in the treatment of breast cancer patients, many of whom require both radiation (RT) and adjuvant TAM. Methods: 160 eligible patients were prospectively randomized 1:1 into two groups: The control group (80 patients) , containing one arm (C) received sequential TAM and RT and the intervention group which was further subdivided into arm (A) (40 patients), received concurrent TAM 20 mg/day with RT, arm( B) (40 patients), received concurrent TAM + Pentoxifylline (PTX) ( 800 mg/day )+ Alpha-Tocopherol (AT) (1000 U/day) and RT. The primary endpoint was to compare the radiation induced pulmonary fibrosis using serial high resolution computed tomography (HRCT) and the role of the PTX and AT combination in reduction of pulmonary fibrosis, the secondary endpoint was to evaluate loco-regional control in the three arms usingChi-Square test, Fisher’s exact test, Log rank test andAnova test. Results: Analysis of the incidence of clinical pneumonitis was 25% in arm A ( TAM) , 12.5% in arm B (TAM+PTX+AT) and 18.8% in arm C (control) with p=.110. The incidence of lung fibrosis was 26.5% in arm A( TAM) , 12.9% in arm B (TAM+VIT.E) and 23.4% in arm C (Control) with p=.608. As regard loco-regional relapse, the preliminary result, revealed no significant difference in the 3 arms (1.3% in control arm, 5 % in TAM, 2.5% in TAM+VIT) (p=.827). Conclusions: It seems that the interaction between tamoxifen and radiotherapy could affect the tissue remodeling rather than the damage induction step of the radiation pathogenesis. In this case, temporal separation of the two modalities (Concurrent Versus Sequential) may not make much difference in the incidence of radiation induced lung fibrosis.

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