Department of Oncology, Experimental Radiation Oncology, KU Leuven-University of Leuven, B-3000, Leuven, Belgium.
Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
Support Care Cancer. 2019 Nov;27(11):4123-4132. doi: 10.1007/s00520-019-04698-0. Epub 2019 Feb 21.
Treatment of breast cancer includes many options and shared decision making is becoming standard practice. Within the context of treatment individualization, the omission of radiotherapy (RT) can be considered. It is thereby of great importance to correctly foresee the side effects attributed to RT. Data from longitudinal studies with contemporary techniques however are sparse. The purpose of the present study was to evaluate patient-reported outcome measures (PROMs) and long-term aesthetic outcome (AO) related to RT in the breast-conserving therapy (BCT) setting for breast cancer over time.
Patients treated with BCT between April 2015 and April 2016 were prospectively included in the cohort. Evaluations were made at six time points: at baseline (before RT), during and at the end of RT, between 3 and 6 months, 1 year and 2 years after RT. AO was scored by the patient and by the BCCT.core software. Further PROMs were measured with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30/-BR23 and the Body Image after Breast Cancer Questionnaire BIBCQ. Patients were evaluated over 2 years. First, we assessed the evolution in time. Second, we tested the differences in mean scale scores of the PROMs between patients with a favourable and an unfavourable AO.
One hundred seventy-five patients were included in the analysis. At baseline, unsatisfactory levels were already present for several scales. Most unsatisfactory PROMs improved up to 1 year after RT. Complaints of fatigue increased at the start but decreased up to a lower level than that at baseline up to 1 year after RT (mean difference (MD) 7.6, - 12.3, respectively). Cognitive functioning showed a small decrease at the start with no further significant decrease (MD - 4.73, - 0.21, respectively). Breast symptoms significantly increased during RT but decreased afterwards up to 2 years after RT to lower values than those at baseline and were then considered satisfactory (MD 15.6, - 19.7, - 4.1, respectively). AO scored as PROM associated with BCCT.core and with the body image measures.
The study suggests that quality of life and body image are temporarily impaired due to RT. Around one third of patients score their long-term AO as unfavourable. These results should be discussed with the patient and could help in the decision making of the treatment plan and in the clarification of the patient's expectations.
乳腺癌的治疗方法有很多，共同决策正成为标准做法。在个体化治疗的背景下，可以考虑省略放射治疗（RT）。因此，正确预测与 RT 相关的副作用非常重要。然而，采用现代技术的纵向研究的数据仍然很少。本研究的目的是评估在乳腺癌保乳治疗（BCT）背景下，随着时间的推移，患者报告的结局测量（PROMs）和与 RT 相关的长期美容结局（AO）。
2015 年 4 月至 2016 年 4 月期间接受 BCT 治疗的患者前瞻性纳入队列。评估在六个时间点进行：基线（RT 前）、RT 期间和结束时、RT 后 3-6 个月、1 年和 2 年。AO 由患者和 BCCT.core 软件评分。进一步通过欧洲癌症研究与治疗组织（EORTC）生活质量问卷 QLQ-C30/-BR23 和乳腺癌后身体形象问卷 BIBCQ 测量其他 PROMs。患者在 2 年内接受评估。首先，我们评估了随时间的变化。其次，我们测试了在 AO 良好和不良的患者之间，PROM 平均量表评分的差异。
175 名患者纳入分析。基线时，一些量表已经存在不满意的水平。大多数不满意的 PROMs 在 RT 后 1 年内得到改善。疲劳症状在开始时增加，但在 RT 后 1 年内下降到低于基线的水平（平均差异（MD）分别为 7.6、-12.3）。认知功能在开始时略有下降，之后没有进一步显著下降（MD 分别为-4.73、-0.21）。乳腺症状在 RT 期间显著增加，但在 RT 后下降到 2 年时低于基线的值，随后被认为是满意的（MD 分别为 15.6、-19.7、-4.1）。AO 根据 BCCT.core 和身体形象测量标准进行评分。
该研究表明，由于 RT，生活质量和身体形象暂时受损。大约三分之一的患者对其长期 AO 评分不满意。这些结果应与患者讨论，并有助于治疗计划的决策和患者期望的明确。
