Department of Radiation Oncology, Loyola University Health System, Maywood, IL, USA.
BMC Cancer. 2012 Jun 18;12:251. doi: 10.1186/1471-2407-12-251.
This pilot study used a prospective longitudinal design to compare the effect of adjuvant whole breast radiation therapy (WBRT) versus partial breast radiation therapy (PBRT) on fatigue, perceived stress, quality of life and natural killer cell activity (NKCA) in women receiving radiation after breast cancer surgery.
Women (N = 30) with early-stage breast cancer received either PBRT, Mammosite brachytherapy at dose of 34 Gy 10 fractions/5 days, (N = 15) or WBRT, 3-D conformal techniques at dose of 50 Gy +10 Gy Boost/30 fractions, (N = 15). Treatment was determined by the attending oncologist after discussion with the patient and the choice was based on tumor stage and clinical need. Women were assessed prior to initiation of radiation therapy and twice after completion of radiation therapy. At each assessment, blood was obtained for determination of NKCA and the following instruments were administered: Perceived Stress Scale (PSS), Functional Assessment of Cancer Therapy-Fatigue (FACT-F), and Functional Assessment of Cancer Therapy-General (FACT-G). Hierarchical linear modeling (HLM) was used to evaluate group differences in initial outcomes and change in outcomes over time.
Fatigue (FACT-F) levels, which were similar prior to radiation therapy, demonstrated a significant difference in trajectory. Women who received PBRT reported progressively lower fatigue; conversely fatigue worsened over time for women who received WBRT. No difference in perceived stress was observed between women who received PBRT or WBRT. Both groups of women reported similar levels of quality of life (FACT-G) prior to initiation of radiation therapy. However, HLM analysis revealed significant group differences in the trajectory of quality of life, such that women receiving PBRT exhibited a linear increase in quality of life over time after completion of radiation therapy; whereas women receiving WBRT showed a decreasing trajectory. NKCA was also similar between therapy groups but additional post hoc analysis revealed that better quality of life significantly predicted higher NKCA regardless of therapy.
Compared to WBRT, PBRT results in more rapid recovery from cancer-related fatigue with improved restoration of quality of life after radiation therapy. Additionally, better quality of life predicts higher NKCA against tumor targets, emphasizing the importance of fostering quality of life for women undergoing adjuvant radiation therapy.
本研究采用前瞻性纵向设计，比较辅助全乳房放射治疗（WBRT）与部分乳房放射治疗（PBRT）对乳腺癌手术后接受放射治疗的女性疲劳、感知压力、生活质量和自然杀伤细胞活性（NKCA）的影响。
30 名早期乳腺癌女性分别接受 PBRT（Mammosite 近距离放疗，剂量 34Gy，10 次/5 天，n=15）或 WBRT（三维适形技术，剂量 50Gy+10Gy 推量/30 次，n=15）。治疗方案由主治肿瘤医生与患者讨论后决定，选择基于肿瘤分期和临床需要。女性在开始放疗前和放疗结束后两次进行评估。每次评估时，采集血液以测定 NKCA，并进行以下仪器评估：感知压力量表（PSS）、癌症治疗功能评估-疲劳量表（FACT-F）和癌症治疗功能评估-一般量表（FACT-G）。采用分层线性模型（HLM）评估组间初始结果差异以及随时间变化的结果变化。
放疗前相似的疲劳（FACT-F）水平表现出明显的轨迹差异。接受 PBRT 的女性报告疲劳逐渐减轻；相反，接受 WBRT 的女性疲劳随时间恶化。接受 PBRT 或 WBRT 的女性之间感知压力无差异。两组女性在开始放疗前报告相似的生活质量（FACT-G）水平。然而，HLM 分析显示生活质量轨迹存在显著的组间差异，接受 PBRT 的女性在放疗结束后随时间呈线性增加，而接受 WBRT 的女性呈下降趋势。NKCA 在治疗组之间也相似，但额外的事后分析表明，无论治疗方式如何，更好的生活质量都显著预测更高的 NKCA。
与 WBRT 相比，PBRT 导致与癌症相关的疲劳更快恢复，放疗后生活质量恢复更好。此外，更好的生活质量预测对肿瘤靶标更高的 NKCA，强调为接受辅助放疗的女性促进生活质量的重要性。
