A Prospective Analysis of Quality of Life and Toxicity Outcomes in Treating Early Breast Cancer With Breast Conservation Therapy and Intraoperative Radiation Therapy

Abstract

Introduction: Intraoperative radiation therapy (IORT) is a minimally invasive radiation option for select patients with early stage breast cancer. This prospective, single institution, pilot study summarizes patient-reported quality of life (QoL) outcomes and clinician-reported toxicity following IORT following breast conservation therapy.Methods: Forty-nine patients were enrolled in a prospective study from 2013 until 2015 to assess QoL and toxicity following breast conservation therapy and IORT. Nine patients did not meet criteria for IORT alone on final pathology and required whole breast irradiation afterwards. These patients were evaluated separately. Validated QoL questionnaires were provided to patients at 1-week, 1-month, and subsequent 6-month intervals for 2 years. Radiation-related toxicity symptoms were evaluated by clinicians at the same time intervals. Likert scale responses were converted to continuous variables to depict patient-reported and clinician-reported outcomes.Results: Outcomes were analyzed as weighted averages of the Likert scale for each symptom. Responses for negative QoL symptoms ranged largely from 0 (none) to 2 (moderate). Responses for positive QoL symptoms ranged largely from 3 (quite a bit) to 4 (very much). Seventy-five percent of patients developed a toxicity; however, 99% of the toxicities were grades 1 and 2. All toxicities demonstrated a downward trend over time, with the exception of breast fibrosis and nodularity, which increased over time. There were no local recurrences upon 2-year follow up.Conclusion: Early stage breast cancer treated with IORT yields favorable QoL outcomes and minimal toxicity profiles with adequate short-term local control.

Gene Expression Profiles Induced by High-dose Ionizing Radiation in MDA-MB-231 Triple-negative Breast Cancer Cell Line

“…As recently described by Sosin et al, IOERT demonstrates favorable patient-reported outcomes and low rates of toxicity with adequate local disease control at 2-year follow-up when implemented in early BC (6). However, the radiosensitivity of BC depends on many factors, including a positive or negative HR status (5).…”

“…As described by several groups including our own, IOERT is a RT technique that can destroy residual cancer cells that may be left at the tumor site, immediately following surgical removal of the tumor (6). According to specific eligibility criteria, IOERT may be exclusive (a single radiation dose of [21][22][23] or an anticipated boost of 9-12 Gy, followed by conventional RT (7)(8)(9)(10)(11)(12)(13).…”

Intra-operative Radiation Therapy versus Whole Breast External Beam Radiotherapy: A Comparison of Patient-Reported Outcomes

“…12 The overall toxicity profile was lower for IORT patients, and qualityadjusted life-years were improved among IORT patients compared to EBRT patients. 13,14 IORT patients reported excellent outcomes but did not offer comparison to EBRT patients. 15 Another study suggested IORT patients reported less general pain and better societal role functioning than EBRT patients, 16 and a third suggested IORT patients reported fewer breast symptoms and body image concerns than EBRT patients.…”

Intraoperative Radiation Therapy Versus Whole Breast Radiation for Early-Stage Breast Cancer Treatment in Rural Appalachia

“…2 Proponents emphasize decreased rates of radiation-induced skin toxicity. 8,9 Post-treatment pain and functionality issues have been reported less frequently in patients undergoing IORT. 10 Additionally, the convenience of a single dose of adjuvant radiation administered intraoperatively can be very appealing in comparison to 4-6 weeks of daily (Monday-Friday) therapy associated with WBRT.…”

“…1,10-12 Lack of access to healthcare and long distances to radiation centers have been shown to prevent patients from completing their course of WBRT, making IORT a reasonable alternative. 8,9,11 This can be useful in rural populations where women may have increased travel difficulties. 13…”