Long-Term Quality-of-Life Results Compared for Two Radiotherapy Strategies After Breast-Conserving Surgery
As reported in The Lancet Oncology by Schäfer et al, little difference in quality of life was observed over long-term follow-up between women receiving accelerated partial-breast irradiation (APBI) with interstitial brachytherapy vs whole-breast irradiation (WBI) after breast-conserving surgery in the European phase III GEC-ESTRO trial. The trial showed that APBI with multicatheter brachytherapy was noninferior to WBI in local control and overall survival.
Study Details
In the trial, patients aged ≥ 40 years with stage 0 to IIA disease were randomized after breast-conserving surgery to receive APBI using multicatheter brachytherapy or WBI of 50 Gy with a boost of 10 Gy. Between April 2004 and July 2009, 633 patients had APBI and 551 had WBI.
The current report presents findings on quality of life over 5-year follow-up, a prespecified secondary endpoint of the trial. Quality-of-life questionnaires (EORTC QLQ-C30 and breast cancer module QLQ-BR23) were completed before radiotherapy; immediately after radiotherapy; at 3 and 6 months posttherapy; and at 1, 3, and 5 years posttherapy.
Quality-of-Life Outcomes
Quality-of-life questionnaires were completed prior to radiotherapy by 53% of patients in the APBI group and 57% of the WBI group, with response rates of 44% and 48% immediately after radiotherapy and 49% and 42% at 5 years. Mean global health status (range = 0–100) in the APBI vs WBI group was 65.5 vs 64.6 (P = .37) before radiotherapy and 66.2 vs 66.0 (P = .94) at 5 years.
The only significant differences indicating at least moderate comparative worsening (10–20 points) between groups during follow-up were for breast symptom scores in the WBI group vs APBI group immediately after radiotherapy (difference of means = 13.6, P < .0001) and at 3 months (difference of means = 12.7, P < .0001). The only significant differences observed at 5 years were worse breast symptoms in the WBI group (difference of means = 5.5, P < .0001) and worse arm symptoms in the WBI group (difference of means = 5.5, P = .033 after adjustment for significantly worse score in WBI group at baseline).
The investigators concluded, “APBI with multicatheter brachytherapy was not associated with worse quality of life compared with whole-breast irradiation. This finding supports APBI as an alternative treatment option after breast-conserving surgery for patients with early breast cancer.”
The study was funded by German Cancer Aid.
Rebekka Schäfer, MD, of the Department of Radiation Oncology, University Hospital Würzburg, Germany, is the corresponding author for The Lancet Oncology article.
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