Quality of life in early breast cancer patients after adjuvant accelerated partial-breast irradiation (APBI) in randomized trial

. 2025 Jan 09 ; 15 (1) : 1387. [epub] 20250109

Jazyk angličtina Země Anglie, Velká Británie Médium electronic

Typ dokumentu časopisecké články, randomizované kontrolované studie, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/pmid39779797

Grantová podpora
MMCI, 00209805 Ministerstvo Zdravotnictví Ceské Republiky
LX22NPO5102 Ministerstvo Školství, Mládeže a Tělovýchovy
LM2023049 Ministerstvo Školství, Mládeže a Tělovýchovy

Odkazy

PubMed 39779797
PubMed Central PMC11711455
DOI 10.1038/s41598-025-85342-2
PII: 10.1038/s41598-025-85342-2
Knihovny.cz E-zdroje

Accelerated partial breast irradiation (APBI) represents a valid option for adjuvant therapy of selected early breast cancer (BC). This single-institution prospective randomized study compares the health-related quality of life (HRQoL) between women treated with the highly conformal-external beam APBI technique and those with the more commonly used moderately hypofractionated whole breast irradiation (hypo-WBI). Eligible patients were women over 50 years with early BC (G1/2 DCIS ≤ 25 mm or G1/2 invasive non-lobular luminal-like HER2 negative carcinoma ≤ 20 mm) after breast-conserving surgery with negative margins. APBI arm consisted of 30 Gy in 5 consecutive daily fractions and WBI arm of 40 Gy in 15 fractions plus 10 Gy in 5 fractions boost to the tumor bed. Patients were requested to complete the official Czech translation of the EORTC QoL questionnaires, including QLQ-C30 and QLQ-BR45, before radiation (baseline), at the end of radiation (M0) and 1 (M1), 3 (M3), 6 (M6), 12 (M12), and 24 (M24) months after radiation. Linear regression models were used to analyze differences in HRQoL between the arms. The 85 enrolled patients exhibited no differences in HRQoL scores between the two arms at baseline. Patients in the APBI arm reported more favorable global health status at M6 (p = 0.055). Other functional scales showed a decrease in the WBI arm at M0 (p = 0.027 for physical functioning). During radiation, symptoms scores increased. Significant between-group differences were observed for the pain (p = 0.002), systemic therapy side effects (p = 0.004), and breast symptoms (p < 0.001) scales at M0, with higher scores in the WBI arm. During follow-up, scores on symptoms scales returned to at least the baseline values. Early BC patients treated with APBI showed non-inferior short-term and late HRQoL outcomes compared to hypo-WBI. In addition to previous findings regarding toxicity, promising pain and breast symptoms results, suggest that APBI should be strongly considered as a treatment option for selected low-risk patients.Trial registration NCT06007118, August 23, 2023 (retrospectively registered).

Zobrazit více v PubMed

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby, S., McGale, P., Correa, C., Taylor, C., Arriagada, R., et al. 2011 Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10801 women in 17 randomised trials. The Lancet378, 1707–1716. PubMed PMC

Strnad, V. et al. Accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy compared with whole-breast irradiation with boost for early breast cancer: 10-Year results of a GEC-ESTRO randomised, phase 3, non-inferiority trial. Lancet Oncol.24, 262–272 (2023). PubMed

Meattini, I. et al. Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer: long-term results of the randomized phase III APBI-IMRT-Florence Trial. J. Clin. Oncol.38, 4175–4183 (2020). PubMed

Coles, C. E. et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet.390, 1048–1060 (2017). PubMed PMC

Whelan, T. J. et al. External beam accelerated partial breast irradiation versus whole breast irradiation after breast conserving surgery in women with ductal carcinoma in situ and node-negative breast cancer (RAPID): A randomised controlled trial. Lancet394, 2165–2172 (2019). PubMed

Vicini, F. A. et al. Long-term primary results of accelerated partial breast irradiation after breast-conserving surgery for early-stage breast cancer: A randomised, phase 3, equivalence trial. Lancet.394, 2155–2164 (2019). PubMed PMC

Greenup, R. A. et al. Cost comparison of radiation treatment options after lumpectomy for breast cancer. Ann. Surg. Oncol.19, 3275–3281 (2012). PubMed

Burkon, P. et al. Toxicity of external beam accelerated partial-breast irradiation (APBI) in adjuvant therapy of early-stage breast cancer: Prospective randomized study. Radiat. Oncol.19, 66 (2024). PubMed PMC

Purdie, T. G. et al. Cone-beam computed tomography for on-line image guidance of lung stereotactic radiotherapy: Localization, verification, and intrafraction tumor position. Int. J. Radiat. Oncol. Biol. Phys.68, 243–252 (2007). PubMed

Bergom, C., Currey, A., Desai, N., Tai, A. & Strauss, J. B. Deep inspiration breath hold: Techniques and advantages for cardiac sparing during breast cancer irradiation. Front. Oncol.8, 66 (2018). PubMed PMC

Latty, D., Stuart, K. E., Wang, W. & Ahern, V. Review of deep inspiration breath-hold techniques for the treatment of breast cancer. J. Med. Radiat. Sci.62, 74–81 (2015). PubMed PMC

Otto, K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med. Phys.35, 310–317 (2008). PubMed

Yan, Y. et al. Dosimetric differences in flattened and flattening filter-free beam treatment plans. J. Med. Phys.41, 92–99 (2016). PubMed PMC

Whelan, T. J. et al. Long-term results of hypofractionated radiation therapy for breast cancer. N. Engl. J. Med.362, 513–520 (2010). PubMed

Aaronson, N. K. et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J. Natl. Cancer Inst.85, 365–376 (1993). PubMed

Bjelic-Radisic, V. et al. An international update of the EORTC questionnaire for assessing quality of life in breast cancer patients: EORTC QLQ-BR45. Ann. Oncol.31, 283–288 (2020). PubMed

EORTC. Scoring of the QLQ-C30 Summary Score.

Sprangers, M. A. et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: First results from a three-country field study. J. Clin. Oncol.14, 2756–2768 (1996). PubMed

EORTC. Manuals / EORTC - Quality of life. https://qol.eortc.org/manuals/. Accessed 24 June 2024.

R Core Team. _R: A Language and Environment for Statistical Computing_ (R Foundation for Statistical Computing, 2023). https://www.r-project.org/. Accessed 15 Feb 2023.

Livi, L. et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-Year survival analysis of a phase 3 randomised controlled trial. Eur. J. Cancer51, 451–463 (2015). PubMed

Franceschini, D. et al. Preliminary results of a randomized study on postmenopausal women with early stage breast cancer: Adjuvant Hypofractionated Whole Breast Irradiation Versus Accelerated Partial Breast Irradiation (HYPAB Trial). Clin. Breast Cancer21, 231–238 (2021). PubMed

Colciago, R. R. et al. One-week external beam partial breast irradiation: Survival and toxicity outcomes. J. Cancer Res. Clin. Oncol.149, 10965–10974 (2023). PubMed PMC

Whelan, T. J., Levine, M., Julian, J., Kirkbride, P. & Skingley, P. The effects of radiation therapy on quality of life of women with breast carcinoma: results of a randomized trial. Ontario Clin. Oncol. Group Cancer88, 2260–2266 (2000). PubMed

Hepel, J. T. et al. Toxicity of three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Int. J. Radiat. Oncol. Biol. Phys.75, 1290–1296 (2009). PubMed

Jagsi, R. et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int. J. Radiat. Oncol. Biol. Phys.76, 71–78 (2010). PubMed PMC

Olivotto, I. A. et al. Interim cosmetic and toxicity results from RAPID: A randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J. Clin. Oncol.31, 4038–4045 (2013). PubMed

Meattini, I. et al. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: Health-related quality of life final analysis from the Florence phase 3 trial. Eur. J. Cancer76, 17–26 (2017). PubMed

Schäfer, R. et al. Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-Year results of a randomised, phase 3 trial. Lancet Oncol.19, 834–844 (2018). PubMed

Corica, T. et al. Cosmesis and breast-related quality of life outcomes after intraoperative radiation therapy for early breast cancer: A substudy of the TARGIT-A Trial. Int. J. Radiat. Oncol. Biol. Phys.96, 55–64 (2016). PubMed

Welzel, G. et al. Health-related quality of life after breast-conserving surgery and intraoperative radiotherapy for breast cancer using low-kilovoltage X-rays. Ann. Surg. Oncol.17(Suppl 3), 359–367 (2010). PubMed

Welzel, G. et al. Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A. Radiat. Oncol.8, 9 (2013). PubMed PMC

Albuquerque, K. et al. Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer. BMC Cancer12, 251 (2012). PubMed PMC

He, Z.-Y. et al. A comparison of quality of life of early breast cancer patients treated with accelerated partial breast irradiation versus whole breast irradiation in China. Breast Cancer Res. Treat.133, 545–552 (2012). PubMed

Wadasadawala, T. et al. Quality of life after accelerated partial breast irradiation in early breast cancer: Matched pair analysis with protracted whole breast radiotherapy. Clin. Oncol. R. Coll. Radiol.21, 668–675 (2009). PubMed

Bitter, S. M. et al. WBRT vs. APBI: An interim report of patient satisfaction and outcomes. J. Contemp. Brachytherapy8, 17–22 (2016). PubMed PMC

Bhattacharya, I. S. et al. Patient-reported outcomes over 5 years after whole- or partial-breast radiotherapy: Longitudinal analysis of the IMPORT LOW (CRUK/06/003) Phase III randomized controlled trial. J. Clin. Oncol.37, 305–317 (2019). PubMed PMC

Ye, X.-P. et al. Accelerated partial breast irradiation for breast cancer: A meta-analysis. Transl. Oncol.6, 619–627 (2013). PubMed PMC

Marta, G. N. et al. Accelerated partial irradiation for breast cancer: Systematic review and meta-analysis of 8653 women in eight randomized trials. Radiother. Oncol.114, 42–9 (2015). PubMed

Taunk, N. K. et al. Comparison of radiation-induced fatigue across 3 different radiotherapeutic methods for early stage breast cancer. Cancer117, 4116–4124 (2011). PubMed

O’Reilly, D. et al. Quality of life in women with early-stage and metastatic hormone receptor-positive, HER2-negative breast cancer receiving endocrine therapy. Oncologist29, 66 (2024). PubMed PMC

Franzoi, M. A. et al. Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy in patients with breast cancer. Lancet Oncol.22, e303–e313 (2021). PubMed

McGee, S. F. et al. A randomized trial comparing concurrent versus sequential radiation and endocrine therapy in early-stage. Hormone-Responsive Breast Cancer Curr. Oncol.31, 4531–4545 (2024). PubMed PMC

Crivellari, D. et al. Hormone therapy in elderly breast cancer patients with comorbidities. Crit. Rev. Oncol. Hematol.73, 92–98 (2010). PubMed

Bartelink, H. et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-Year follow-up of a randomised phase 3 trial. Lancet Oncol.16, 47–56 (2015). PubMed

Gradishar, W. J. et al. NCCN Guidelines® Insights: Breast Cancer Version 4.2023. J. Natl. Compr. Cancer Netw.21, 594–608 (2023). PubMed

Zobrazit více v PubMed

ClinicalTrials.gov
NCT06007118

Najít záznam

Citační ukazatele

Nahrávání dat ...

Možnosti archivace

Nahrávání dat ...