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. 2017 Apr;162(2):329-342.
doi: 10.1007/s10549-017-4121-z. Epub 2017 Jan 28.

Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

M Pérez  1 , M Schootman  2   3 , L E Hall  3   4 , D B Jeffe  5   3
Affiliations

Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

M Pérez et al. Breast Cancer Res Treat. 2017 Apr.

Abstract

Purpose: Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type.

Methods: We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤3.0 cm and lymph node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 "not at all" to 5 "all the time") and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors.

Results: Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up.

Conclusions: Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.

Keywords: Accelerated treatments; Breast cancer; Quality of life; Radiation therapy; Side effects.

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Conflict of interest statement

Conflict of Interest: The authors declare that they have no conflicts of interest, financial or otherwise.

Figures

Fig. 1
Fig. 1
Repeated-measures analysis of covariance of severity of fatigue at Time1 and Time2 by type of radiation therapy (RT)—whole breast radiation therapy (WBRT) or accelerated partial breast irradiation (APBI)—for those 120 patients who had initiated RT at Time1, adjusting for all covariates. Higher scores indicate greater severity of fatigue. Women who received WBRT reported a greater increase in fatigue at Time2 than women who received APBI (P < 0.001).
Fig. 2
Fig. 2
Repeated-measures analysis of covariance of severity of skin irritation at Time1 and Time2 by type of radiation therapy (RT)—whole breast radiation therapy (WBRT) or accelerated partial breast irradiation (APBI)—for those 120 patients who had initiated RT at Time1, adjusting for all covariates. Higher scores indicate greater severity of skin irritation. Women who received WBRT reported a greater increase in skin irritation at Time2 (P < 0.001) than women who received APBI.
Fig. 3
Fig. 3
Repeated-measures analysis of covariance of RAND 36-item Health Survey Vitality subscale scores over time by type of radiation therapy (RT)—whole breast radiation therapy (WBRT) or accelerated partial breast irradiation (APBI)—adjusting for all covariates (N = 268). Higher scores indicate greater vitality. Change over time was not statistically significant regardless of type of RT.
Fig. 4
Fig. 4
Repeated-measures analysis of covariance of total FACT-B scores over time by type of radiation therapy (RT)—whole breast radiation therapy (WBRT) or accelerated partial breast irradiation (APBI)—adjusting for all covariates (N = 267). Higher scores indicate better quality of life. Change over time was not statistically significant regardless of type of RT.
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