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The value of adjuvant chemotherapy has been convincingly demonstrated in breast cancer patients with involved axillary nodes. In the last three decades, incremental benefits in breast cancer disease-free survival (DFS) and overall survival (OS) have occurred with the introduction of anthracycline and taxane adjuvant chemotherapy regimens and with the exploration of higher doses (dose intense) and more frequent administration of these drugs (dose dense)1-3. The importance of dose-intensity for adjuvant chemotherapy in patients with breast cancer has first been described by Hryniuk et al.4. Higher dose-intensity can be achieved by either increasing the single dose per cycle (i.e. higher dose) or by reducing the intervals between cycles (i.e. dose density)5. The concept called log-cell kill postulated that a given dose of an antineoplastic compound would always kill a certain fraction of the tumor, regardless of the number of cells present. On the basis of that model, higher doses are supposed to be more effective because the fraction of destroyed cancer cells will increase with intensification of the dose. However, the impact of therapy is not only associated with the tumor-cell kill by each dose but also with the rate of cancer regrowth between cycles6. Gompertzian kinetics suggest that micrometastases in the adjuvant setting grow faster than established macrometastases; thus, there is likely a higher regrowth of micrometastases between the cycles. Therefore, the administration of cytotoxic drugs with a shortened interval between treatments would be an even more Kasr El-aini J. Clin. Oncol. nucl. med.

Dose-Dense Chemotherapy in High-Risk Breast Cancer: Treatment Outcome and Toxicity