A prospective longitudinal clinical trial evaluating quality of life after breast-conserving surgery and high-dose-rate interstitial brachytherapy for early-stage breast cancer

Abstract

Purpose: To prospectively examine quality of life (QOL) of patients with early stage breast cancer treated with accelerated partial breast irradiation (APBI) using high-dose-rate (HDR) interstitial brachytherapy.

Methods and materials: Between March 2004 and December 2008, 151 patients with early stage breast cancer were enrolled in a phase 2 prospective clinical trial. Eligible patients included those with Tis-T2 tumors measuring ≤3 cm excised with negative surgical margins and with no nodal involvement. Patients received 3.4 Gy twice daily to a total dose of 34 Gy. QOL was measured using European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, version 3.0, and QLQ-BR23 questionnaires. The QLQ-C30 and QLQ-BR23 questionnaires were evaluated during pretreatment and then at 6 to 8 weeks, 3 to 4 months, 6 to 8 months, and 1 and 2 years after treatment.

Results: The median follow-up was 55 months. Breast symptom scores remained stable in the months after treatment, and they significantly improved 6 to 8 months after treatment. Scores for emotional functioning, social functioning, and future perspective showed significant improvement 2 years after treatment. Symptomatic fat necrosis was associated with several changes in QOL, including increased pain, breast symptoms, systemic treatment side effects, dyspnea, and fatigue, as well as decreased role functioning, emotional functioning, and social functioning.

Conclusions: HDR multicatheter interstitial brachytherapy was well tolerated, with no significant detrimental effect on measured QOL scales/items through 2 years of follow-up. Compared to pretreatment scores, there was improvement in breast symptoms, emotional functioning, social functioning, and future perspective 2 years after treatment.

Conflict of interest statement

Conflicts of Interest: None

Copyright © 2013 Elsevier Inc. All rights reserved.

Figures

Figure 1

Changes in quality of life over time for the (a) QLQ-C30 and (b) QLQ-BR23 questionnaires. These graphs show changes in mean quality-of-life scores over time for each domain. All scores were linearly converted to a 0–100-point scale. For the functional and global health status/QOL scales, higher scores represent a better level of functioning. For the symptom scales, higher scores represent a greater degree of symptoms. Error bars represent 95% confidence intervals. Asterisks (*) designate time points at which differences from baseline were significant. Abbreviations: pretx = pretreatment; wks = weeks

Figure 1

Changes in quality of life over time for the (a) QLQ-C30 and (b) QLQ-BR23 questionnaires. These graphs show changes in mean quality-of-life scores over time for each domain. All scores were linearly converted to a 0–100-point scale. For the functional and global health status/QOL scales, higher scores represent a better level of functioning. For the symptom scales, higher scores represent a greater degree of symptoms. Error bars represent 95% confidence intervals. Asterisks (*) designate time points at which differences from baseline were significant. Abbreviations: pretx = pretreatment; wks = weeks