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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2010

01-10-2010 | American Society of Breast Surgeons

Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays

Authors: Grit Welzel, Frank Hofmann, Elena Blank, Uta Kraus-Tiefenbacher, Brigitte Hermann, Marc Sütterlin, Frederik Wenz

Published in: Annals of Surgical Oncology | Special Issue 3/2010

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Abstract

Background

Intraoperative radiotherapy (IORT) is currently being evaluated as a novel approach during breast-conserving surgery (BCS). IORT can be used either as a tumor bed boost followed by external-beam radiotherapy (EBRT) or as a single treatment. In a matched-pair study, we assessed quality of life (QoL) in 69 patients with early breast cancer treated with BCS and/or IORT and/or EBRT.

Methods

Patients were matched for age and time since BCS. IORT was provided with 50 kV x-rays (Intrabeam) delivering 20 Gy at the applicator surface. EBRT (46 to 50 Gy in 2-Gy fractions in the IORT with EBRT group, and 56 Gy in 2-Gy fractions in the EBRT group) was initiated after completion of wound healing and/or chemotherapy. The mailed questionnaires included the European Organization for the Research and Treatment of Cancer QLQ-C30 and BR23, FACT-F, HADS, Body Image Scale, and Rosenberg Self-Esteem Scale. At 18 to 70 months’ follow-up (median 47 months), all patients were disease free.

Results

We found only a few differences between the three groups. There was a trend toward more pain (mean ± standard deviation; 42.8 ± 32.9 vs. 27.5 ± 34.7) and reduced QoL (57.6 ± 20.7 vs. 70.3 ± 23.9) after IORT with EBRT compared with EBRT, respectively. IORT patients reported comparable QoL (70.3 ± 23.0), and less breast symptoms and body image concerns compared to EBRT (8.6 ± 12.3 vs. 19.2 ± 23.8, and 1.7 ± 3.3 vs. 3.4 ± 4.4, respectively). IORT alone resulted in significantly fewer breast symptoms (8.6 ± 12.3; P = 0.012) and less pain (23.9 ± 24.5, P = 0.041) compared with IORT with EBRT (26.1 ± 27.6; 42.8 ± 32.9, respectively).

Conclusions

Patients with early breast cancer after BCS and IORT with or without EBRT present with comparable QoL like patients receiving EBRT without a boost. IORT patients show the lowest rate of breast symptoms.
Literature
1.
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRefPubMed
2.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRefPubMed
3.
Fallowfield LJ. Psychosocial adjustment after treatment for early breast cancer. Oncology. 1990;4:89–97.PubMed
4.
Ganz PA, Schag AC, Lee JJ, Polinsky ML, Tan SJ. Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer. 1992;69:1729–38.CrossRefPubMed
5.
Sneeuw KCA, Aaronson NK, Yarnold JR, et al. Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients’ ratings, observers’ ratings and objective assessments. Radiother Oncol. 1992;25:153–9.CrossRefPubMed
6.
Stanton AL, Estes MA, Estes NC, et al. Treatment decision making and adjustment to breast cancer: a longitudinal study. J Consul Clin Psychol. 1998;66:313–22.CrossRef
7.
Janni W, Rjosk D, Dimpfl TH, et al. Quality of life influenced by primary surgical treatment for stage I–III breast cancer—long-term follow-up of a matched-pair analysis. Ann Surg Oncol. 2001;8:542–8.PubMed
8.
Sacchini V, Luini A, Agresti R, et al. The influence of radiotherapy on cosmetic outcome after breast conservative surgery. Int J Radiat Oncol Biol Phys. 1995;33:59–64.PubMed
9.
Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA. The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol. 1999;25:566–70.CrossRefPubMed
10.
Moyer A. Psychosocial outcomes of breast-conserving surgery versus mastectomy: a meta-analytic review. Health Psychol. 1997;16:284–98.CrossRefPubMed
11.
Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer. 2000;36:1938–43.CrossRefPubMed
12.
Härtl K, Janni W, Kästner R, et al. Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. Ann Oncol. 2003;14:1064–71.CrossRefPubMed
13.
Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J. 2004;10:223–31.CrossRefPubMed
14.
Arndt V, Stegmaier C, Ziegler H, Brenner H. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol. 2008;134:1311–8.CrossRefPubMed
15.
Rayan G, Dawson LA, Bezjak A, et al. Prospective comparison of breast pain in patients participating in a randomised trial of breast-conserving surgery and tamoxifen with or without radiotherapy. Int J Radiat Oncol Biol Phys. 2003;55:154–61.CrossRefPubMed
16.
Prescott RJ, Kunkler IH, Williams LJ, et al. A randomised controlled trial of postoperative radiotherapy following breast-conserving surgery in a minimum-risk older population. The PRIME trial. Health Technol Assess. 2007;11:1–149, iii–iv.
17.
Whelan TJ, Levine M, Julian J, Kirkbride P, Skingley P, for the Ontario Clinical Oncology Group. The effects of radiation therapy on quality of life of women with breast carcinoma: results of a randomized trial. Cancer. 2000;88:2260–6.
18.
Lee TS, Kilbreath SL, Refshauge KM, et al. Quality of life of women treated with radiotherapy for breast cancer. Support Care Cancer 2008:399–405.
19.
Amichetti M, Caffo O. Quality of life in patients with early stage breast carcinoma treated with conservation surgery and radiotherapy. An Italian monoinstitutional study. Tumori. 2001;87:78–84.PubMed
20.
Mandelblatt JS, Edge SB, Meropol NJ, et al. Predictors of long term outcomes in older breast cancer survivors: perceptions versus patterns of care. J Clin Oncol. 2003;21:855–63.CrossRefPubMed
21.
Waljee JF, Hu ES, Ubel PA, et al. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26:3331–7.CrossRefPubMed
22.
Freedman GM, Li T, Anderson PR, Nicolaou N, Konski A. Health states of women after conservative surgery and radiation for breast cancer. Breast Cancer Res Treat. 2010;121:519–26.CrossRefPubMed
23.
Kraus-Tiefenbacher U, Steil V, Bauer L, Melchert F, Wenz F. A novel mobile device for intraoperative radiotherapy (IORT). Onkologie. 2003;26:596–8.CrossRefPubMed
24.
Vaidya JS, Tobias JS, Baum M, et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol. 2004;5:165–73.CrossRefPubMed
25.
Kraus-Tiefenbacher U, Scheda A, Steil V, et al. Intraoperative radiotherapy (IORT) for breast cancer using the intrabeam system. Tumori. 2005;91:339–45.PubMed
26.
Vaidya JS, Baum M, Tobias JS, et al. Targeted intraoperative radiotherapy (TARGIT) yields very low recurrence rates when given as a boost. Int J Radiat Oncol Biol Phys. 2006;66:1335–8.PubMed
27.
Kraus-Tiefenbacher U, Bauer L, Kehrer T, et al. Intraoperative radiotherapy (IORT) as a boost in patients with early-stage breast cancer—acute toxicity. Onkologie. 2006;29:77–82.CrossRefPubMed
28.
Kraus-Tiefenbacher U, Bauer L, Scheda A, et al. Long-term toxicity of an intraoperative radiotherapy (IORT) boost using low energy X-rays during breast-conserving surgery. Int J Radiat Oncol Biol Phys. 2006;66:377–81.PubMed
29.
Reitsamer R, Sedlmayer F, Kopp M, et al. The salzburg concept of intraoperative radiotherapy for breast cancer: results and considerations. Int J Cancer. 2006;118:2882–7.CrossRefPubMed
30.
Vaidya JS, Tobias JS, Baum M, et al. Targeted intraoperative radiotherapy (TARGIT): an innovative approach to partial-breast irradiation. Semin Radiat Oncol. 2005;15:84–91.CrossRefPubMed
31.
Intra M, Luini A, Gatti G, et al. Surgical technique of intraoperative radiation therapy with electrons (ELIOT) in breast cancer: a lesson learned by over 1000 procedures. Surgery. 2006;140:467–71.CrossRefPubMed
32.
Salvadori B, Marubini E, Miceli R, et al. Reoperation for locally recurrent breast cancer in patients previously treated with conservative surgery. Br J Surg. 1999;86:84–7.CrossRefPubMed
33.
Offersen BV, Overgaard M, Kroman N, Overgaard J. Accelerated partial breast irradiation as part of breast conserving therapy of early breast carcinoma: a systematic review. Radiother Oncol. 2009;90:1–13.CrossRefPubMed
34.
Lemanski C, Azria D, Gourgon-Bourgade S, et al. Intraoperative radiotherapy in early-stage breast cancer: results of the Montpellier phase II trial. Int J Radiat Oncol Biol Phys. 2010;76:698–703.PubMed
35.
Lemanski C, Azria D, Thezenas S, et al. Intraoperative radiotherapy given as a boost for early breast cancer: long-term clinical and cosmetic results. Int J Radiat Oncol Biol Phys. 2006;64:1410–5.PubMed
36.
Wenz F, Welzel G, Keller A, et al. Early initiation of external beam radiotherapy (EBRT) may increase the risk of long-term toxicity in patients undergoing intraoperative radiotherapy (IORT) as a boost for breast cancer. Breast. 2008;17:617–22.CrossRefPubMed
37.
Wenz F, Welzel G, Blank E, et al. Intraoperative radiotherapy as a boost during breast-conserving surgery using low-kilovoltage x-rays: the first 5 years of experience with a novel approach. Int J Radiat Oncol Biol Phys. 2010;77:1309–14.PubMed
38.
Aaronson NK, Ahmedzai S, Bergmann B, 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. 1993;85:365–76.CrossRefPubMed
39.
Sprangers MA, Groenvold M, Arraras JI, 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. 1996;14:2756–68.PubMed
40.
Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients. Eur J Cancer. 2001;37:189–97.CrossRefPubMed
41.
Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997;13:63–74.CrossRefPubMed
42.
Cella D. The Functional Assessment of Cancer Therapy—Anemia (FACT-AN) scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol. 1997;34:13–9.PubMed
43.
Cella D, Lai JS, Chang CH, Peterman A, Slavin M. Fatigue in cancer patients compared with fatigue in the general United States population. Cancer. 2002;94:528–38.CrossRefPubMed
44.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
45.
Herrmann C, Buss U, Snaith RP. HADS-D: Hospital anxiety and depression scale—Deutsche version (German version). Ein fragebogen zur erfassung von angst und depressivität in der somatischen medizin. Bern, Switzerland: Huber; 1995.
46.
Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press; 1965.
47.
Schmitt DP, Allik J. Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: exploring the universal and culture-specific features of global self-esteem. J Pers Soc Psychol. 2005;89:623–42.CrossRefPubMed
48.
Fayers P, Aaronson NK, Bjordal K, Curran D, Groenvold M, on behalf of the EORTC Quality of Life Study Group. EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: EORTC Quality of Life Group; 2001.
49.
LENT SOMA tables. Radiother Oncol. 1995;35:17–60.
50.
Denekamp J, Bartelink H, Rubin P. Correction for the use of the SOMA LENT tables. American and European LENT Working Committees. Radiother Oncol. 1996;39:191.CrossRefPubMed
51.
Bayerl A, Frank D, Lenz A, et al. [Local tumor control and cosmetic outcome following breast-conserving surgery and radiation up to a total dose of 56 Gy without boost in breast cancer]. Strahlenther Onkol. 2001;177:25–32.CrossRefPubMed
52.
Janda M, Newman B, Obermair A, et al. Impaired quality of life in patients commencing radiotherapy for cancer. Strahlenther Onkol. 2004;180:78–83.CrossRefPubMed
53.
Galalae RM, Michel J, Siebmann JU, et al. Significant negative impact of adjuvant chemotherapy on health-related quality of life (HR-QOL) in women with breast cancer treated by conserving surgery and postoperative 3-D radiotherapy. A prospective measurement. Strahlenther Onkol. 2005;181:645–51.CrossRefPubMed
54.
Scott NW, Fayers PM, Aaronson NK, et al. EORTC QLQ-C30 reference values. Brussels: Quality of Life Department, EORTC Headquarters; 2008.
55.
Schwarz R, Hinz A. Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer. 2001;37:1345–51.CrossRefPubMed
56.
Hopwood P, Haviland JS, Sumo G, et al, on behalf of the START Trial Management Group. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol. 2010;11:231–40.CrossRefPubMed
57.
Kenny P, King MT, Sheill A, et al. Early stage breast cancer, costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy. Breast. 2000;9:37–44.CrossRefPubMed
58.
Wadasadawala T, Budrukkar A, Chopra S, et al. Quality of life after accelerated partial breast irradiation in early breast cancer: matched pair analysis with protracted whole breast radiotherapy. Clin Oncol. 2009;21:668–75.CrossRef
59.
Belkacémi Y, Chauvet MP, Giard S, et al. Partial breast irradiation as sole therapy for low risk breast carcinoma: early toxicity, cosmesis and quality of life results of a mammosite brachytherapy phase II study. Radiother Oncol. 2009;90:23–9.CrossRefPubMed
60.
Albuquerque K, Janusek L, Mathews H, Millbrandt L, Gabram S. Short-term quality of life following partial breast irradiation with balloon brachytherapy—comparison with whole breast irradiation. Breast J. 2010;16:325–6.CrossRefPubMed
Metadata
Title
Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays
Authors
Grit Welzel
Frank Hofmann
Elena Blank
Uta Kraus-Tiefenbacher
Brigitte Hermann
Marc Sütterlin
Frederik Wenz
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1257-z

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