GEC-ESTRO: Long-term QoL outcomes similar regardless of irradiation choice
medwireNews: Women with early breast cancer have similar quality of life (QoL) at 5 years whether they are treated with accelerated partial breast irradiation (APBI) using multicatheter brachytherapy or whole-breast irradiation, GEC-ESTRO data show.
“This trial provides further clinical evidence that APBI with interstitial brachytherapy can be considered as an alternative treatment option after breast-conserving surgery for patients with low-risk breast cancer,” Rebekka Schäfer (University Hospital Würzburg, Germany) and co-authors write in The Lancet Oncology.
The GEC-ESTRO researchers previously reported that APBI using multicatheter brachytherapy was as effective as whole-breast irradiation in terms of local control and overall survival when used after breast-conserving surgery (resection margins ≥2 mm) in women aged 40 years and older with stage 0–IIA breast cancer.
For the current analysis, they studied patient-reported QoL data collected after breast-conserving surgery but before radiotherapy (baseline 1), immediately after radiotherapy (baseline 2), and during 5 years of follow-up. The response rate at each time point was around 50%.
Schäfer and team found no clinically significant difference in global health status, as assessed by the EORTC QLQ-C30 questionnaire, between the two groups at any time during follow-up.
Specifically, the mean score, on a scale of 1–100, at baseline 1 was 65.5 in the APBI group and 64.6 in the whole-breast irradiation group. The corresponding values were 62.9 and 62.4 at baseline 2, 68.9 and 64.3 at 3 months, and 66.2 and 66.0 at 5 years. The difference of 4.6 points at 3 months, although statistically significant, was not considered clinically relevant .
The only clinically relevant moderate difference (10–20 points) between the two treatment modalities was observed in the breast symptoms scale at baseline 2 and 3 months when breast symptoms, such as swelling, pain, and skin problems, were a respective 13.6 and 12.7 points worse in patients who had whole-breast irradiation compared with those who had APBI.
“This finding reflects the acute side-effects of external beam irradiation of the whole breast,” Schäfer et al remark.
The study findings were also presented at ESTRO 37, the annual meeting of the European Society for Radiotherapy & Oncology, in Barcelona, Spain. Speaking to press at the meeting, Schäfer said: “More and more women are surviving breast cancer for longer and longer, so we need to be sure that treatments do not detract from their quality of life in the long term.”
She added that the data may allow patients to make treatment choices that are better suited to their personal circumstances, explaining that APBI “allows us to deliver a higher dose of radiation to a smaller area, which means the course of treatment is shortened from three to six weeks down to one week or less.”
Schäfer explained: “For a variety of reasons patients may find it difficult to manage a treatment schedule that lasts up to six weeks. They may have to travel a long way to reach hospital, or they may wish to return to work as soon as possible, so they might prefer a treatment that can be carried out in a week or less.”
By Laura Cowen
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