Pérez M, Schootman M, Hall L E, Jeffe D B
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA.
Breast Cancer Res Treat. 2017 Apr;162(2):329-342. doi: 10.1007/s10549-017-4121-z. Epub 2017 Jan 28.
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.
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.
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.
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.
早期乳腺癌患者保乳手术后进行放疗（RT），其生存获益与全乳放疗（WBRT）或加速部分乳腺照射（APBI）相似。然而，放疗类型和副作用严重程度对生活质量（QOL）变化的影响尚不清楚。我们通过放疗类型研究了放疗副作用严重程度和QOL的变化。
我们分析了一组285例新诊断的肿瘤大小≤3.0 cm且无淋巴结转移的早期乳腺癌患者的数据。患者（93例[32.6%]为0期；49例[17.2%]为非白人；平均年龄 = 59.3岁）在确定性手术治疗后完成了四次访谈（6周、6个月、12个月和24个月）。我们使用5分制量表（1“完全没有”至5“一直有”）测量放疗副作用、疲劳和皮肤刺激的严重程度，并使用癌症治疗功能评估-乳腺（FACT-B）和兰德36项健康调查活力子量表测量QOL。对每个结局进行重复测量协方差分析，控制人口统计学、临床/治疗和心理社会因素。
患者在6个月内开始放疗（113例接受APBI；172例接受WBRT），并在12个月内完成放疗。从6周访谈至6个月访谈，接受WBRT（与APBI相比）的患者报告疲劳和皮肤刺激严重程度增加更大（均P < 0.001）。在2年随访期间，总FACT-B和活力的改善在放疗类型上没有显著差异。
研究结果表明，早期乳腺癌患者可从APBI较轻的短期副作用中获益，且在2年随访期内对QOL变化无差异影响。
