BackgroundBecause early‐stage breast cancer can be treated successfully by a variety of breast‐conservation approaches, long‐term quality of life (QoL) is an important consideration in assessing treatment outcomes for these patients. This study compares patient‐reported QoL outcomes among women with stage 0‐2 disease treated via lumpectomy followed by whole breast irradiation (WBI) or partial breast proton irradiation (PBPT).MethodsIn this cross‐sectional study, 129 participants evaluated QoL several years post‐treatment by responding to subjective instruments, including established scalar questionnaires and self‐report measures. Responses were averaged between the two groups.ResultsAt 6.5 years (median) postdiagnosis, participants’ demographic, and clinical characteristics were similar. Patient‐reported outcomes were reported as mean scale scores for the two groups, all displaying significant differences favoring PBPT, including: cosmetic breast cancer treatment outcome scale (BCTOS) (PBPT mean 1.45, WBI mean 1.88, P < 0.001); breast pain (PBPT mean 1.30, WBI mean 1.67, P < 0.05); breast texture (BPT mean 1.44, WBI mean 1.91, P < 0.001); clothing fit (PBPT mean 1.06, WBI 1.46, P < 0.001); fatigue (PBPT mean 2.24, WBI mean 3.77, P < 0.002); impact of daily life fatigue on personal relations (OBPT mean 0.83, WBI mean 2.15, P < 0.001); and self‐consciousness (appearance dissatisfaction) (PBPT mean 1.38, WBI mean 1.77, P < 0.004).ConclusionPatients’ responses suggest that PBPT is associated with improved overall QoL compared to standard whole breast treatment. These self‐perceptions are reported by patients who are 5‐10 years post‐treatment, and that PBPT may enhance QoL in a multitude of interrelated ways.
and the contralateral lung V5 to 5%, thereby effectively precluding the use of IMRT/VMAT. Here, we update the long term pulmonary outcomes of patients treated with IMRT/VMAT since our initial report of early toxicity in 2013. Materials/Methods: Between 2010 and 2012, we prospectively enrolled 106 patients to receive adjuvant chest-wall and regional-nodal irradiation following mastectomy for invasive breast cancer. Radiation was administered to a total dose of 50Gy in 2Gy daily fractions using multi-field IMRT or VMAT techniques, typically without a chest wall or scar boost. Results: The median age was 49 (range 25-76) with a median follow-up of 3.2 years. Among the overall cohort, median D95 to the planning target volume (PTV) was 48.1Gy (range 47.0 e 50.2Gy; prescription dose Z 50Gy). Pulmonary metrics included a median ipsilateral lung V5 of 100% (range 77-100%), median V20 of 29% (range 22.5-31%) and median ipsilateral mean lung dose of 19.3Gy (range 6.6-21.5Gy). The contralateral lung received a median V5 of 79.3% (range 0-99.9%), median V20 of 0.65% (range 0 e 21.4%), and the median contralateral mean lung dose was 7.1Gy (range 4.4 e 11.5 Gy). Early evaluation at 6 months revealed 11 patients with any pulmonary toxicity, one of whom had grade 3 pneumonitis. By 3 years of follow-up, only five patients (4.7%) were noted to have mild respiratory symptoms (limited to cough or dyspnea), none requiring intervention, and none definitively attributed to radiotherapy. Conclusion: This prospective study demonstrates that multi-field IMRT/ VMAT results in excellent tumor target coverage, but with a high V5 of the lungs. Despite relatively high lung V5 values, the rates of pulmonary toxicity were low overall. The clinical significance of the lung V5 to predict pulmonary toxicity in breast cancer does not apply to IMRT-based planning.
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