Quality of Life With Postmastectomy Radiotherapy vs No Radiotherapy in Intermediate-Risk Breast Cancer
In a 2-year follow-up of the phase III SUPREMO trial reported in The Lancet Oncology, Velikova et al found worse chest wall symptoms in women with intermediate-risk breast cancer who did vs did not receive postmastectomy radiotherapy. No other differences in quality-of-life outcomes were found between the two groups.
Study Details
The prespecified quality-of-life substudy involved a UK cohort of an international trial (n = 1,688) in which women with intermediate-risk breast cancer (defined as pT1–2, N1; pT3, N0; or pT2, N0 if also grade III or with lymphovascular invasion) who had undergone mastectomy—and axillary surgery if node-positive—were randomly assigned to receive chest wall radiotherapy (50 Gy in 25 fractions or a radiobiologically equivalent dose of 45 Gy in 20 fractions or 40 Gy in 15 fractions) or no radiotherapy.
The primary endpoint of the trial is 10-year overall survival. In the quality-of-life substudy, 487 patients in the radiotherapy group and 502 in the no-radiotherapy group were assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23, Body Image Scale, Hospital Anxiety and Depression Scale, and EQ-5D-3L. A total of 947 patients (96%) completed baseline questionnaires and were included in the analysis (471 in radiotherapy group, 476 in no radiotherapy group).
Quality-of-Life Outcomes at 2 Years
At up to 2 years, chest wall symptoms were worse in the radiotherapy group vs the no-radiotherapy group (mean scores = 14.1 vs 11.6, effect estimate = 2.17, P = .016). Improvement in chest wall symptoms was observed in both groups between year 1 and year 2 (visit effect estimate = -1.34, P = .010), although the improvement was greater in the no-radiotherapy group (adjusted mean change in scores = −3.13 in radiotherapy group vs −5.30 in no-radiotherapy group). No significant differences between groups were observed for arm and shoulder symptoms, body image, fatigue, overall quality of life, physical function, or anxiety and depression scores.
The investigators concluded, “Postmastectomy radiotherapy led to more local (chest wall) symptoms up to 2 years postrandomization compared with no radiotherapy, but the difference between groups was small. These data will inform shared decision-making while we await survival (trial primary endpoint) results.”
The study was funded by the Medical Research Council, European Organisation for Research and Treatment of Cancer, Cancer Australia, Dutch Cancer Society, and Trustees of Hong Kong and Shanghai Banking Corporation.
Galina Velikova, PhD, of the Leeds Cancer Centre, St James’s University Hospital, is the corresponding author for The Lancet Oncology article.
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