Health-related quality of life of breast cancer patients after accelerated partial breast irradiation using intraoperative or external beam radiotherapy technique

D H M Jacobs; N Horeweg; M Straver; E M A Roeloffzen; G Speijer; J Merkus; J van der Sijp; M E Mast; U Fisscher; A L Petoukhova; A G Zwanenburg; C A M Marijnen; P C M Koper

doi:10.1016/j.breast.2019.04.006

Health-related quality of life of breast cancer patients after accelerated partial breast irradiation using intraoperative or external beam radiotherapy technique

Breast. 2019 Aug:46:32-39. doi: 10.1016/j.breast.2019.04.006. Epub 2019 Apr 28.

Authors

D H M Jacobs¹, N Horeweg², M Straver³, E M A Roeloffzen⁴, G Speijer⁵, J Merkus⁶, J van der Sijp³, M E Mast⁷, U Fisscher⁷, A L Petoukhova⁷, A G Zwanenburg⁴, C A M Marijnen², P C M Koper⁷

Affiliations

¹ Department of Radiation Oncology, Haaglanden Medical Centre, The Hague, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands. Electronic address: d.h.m.jacobs@lumc.nl.
² Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands.
³ Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands.
⁴ Department of Radiation Oncology, Isala, Zwolle, the Netherlands.
⁵ Department of Radiation Oncology, Haga Hospital, The Hague, the Netherlands.
⁶ Department of Surgery, Haga Hospital, The Hague, the Netherlands.
⁷ Department of Radiation Oncology, Haaglanden Medical Centre, The Hague, the Netherlands.

PMID: 31075670
DOI: 10.1016/j.breast.2019.04.006

Abstract

Purpose: To compare health-related quality of life (HRQL) in elderly breast cancer patients between two types of Accelerated Partial Breast Irradiation: intraoperative radiotherapy (IORT) and external beam APBI (EB-APBI).

Methods: Between 2011 and 2016 women ≥60 years undergoing breast conserving therapy for early stage breast cancer were included in a prospective multi-centre cohort study. Patients were treated with electron IORT (1 × 23.3 Gy) or photon EB-APBI (10 × 3.85 Gy daily). HRQL was measured by the EORTC-QLQ C30 and BR23 questionnaires before surgery and at several time points until 1 year.

Results: HRQoL data was available of 204 IORT and 158 EB-APBI patients. In longitudinal analyses emotional functioning and future perspective were significantly, but not clinically relevantly, worse in IORT-treated patients, and improved significantly during follow-up in both groups. All other aspects of HRQL slightly worsened after treatment and recovered within 3 months with an improvement until 1 year. Cross-sectional analysis showed that postoperatively fatigue and role functioning were significantly worse in IORT patients compared to EB-APBI patients who were not yet irradiated, but the difference was not clinically relevant. At other timepoints there were no significant differences. Multivariable analysis at 1 year identified comorbidity and systemic therapy as risk factors for a worse global health score (GHS).

Conclusions: EB-APBI and IORT were well tolerated. Despite a temporary deterioration after treatment, all HRQL scales recovered within 3 months resulting in no clinically relevant differences until 1 year between groups nor compared to baseline levels.

Keywords: Accelerated partial breast irradiation; Breast cancer; Elderly; Intraoperative radiotherapy; Quality of life.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Aged
Breast Neoplasms / psychology
Breast Neoplasms / radiotherapy*
Cross-Sectional Studies
Female
Humans
Intraoperative Care / methods
Intraoperative Care / psychology*
Longitudinal Studies
Mastectomy, Segmental / methods
Mastectomy, Segmental / psychology
Middle Aged
Postoperative Period
Prospective Studies
Quality of Life*
Radiotherapy Dosage
Radiotherapy, Adjuvant / methods
Radiotherapy, Adjuvant / psychology*
Treatment Outcome