Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays

Welzel, Grit; Hofmann, Frank; Blank, E.; Kraus-Tiefenbacher, U.; Hermann, Brigitte; Sütterlin, Marc; Wenz, Frederik

doi:10.1245/s10434-010-1257-z

Cited by 41 publications

(39 citation statements)

References 52 publications

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“…Some of our data confirm a previous study by our group reporting on fewer breast symptoms and less general pain symptoms after IORT alone compared to IORT as a tumor bed boost followed by EBRT in breast cancer patients treated outside of the TARGIT-A trial [7]. In the present study, a single-center subgroup of patients of the TARGIT-A trial treated with IORT alone were found to have a significantly better radiation-related QoL than those treated with EBRT as assessed by restrictions in daily activities (role functioning), general pain, breast, and arm symptoms.…”

Section: Discussionsupporting

confidence: 89%

Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A

et al. 2013

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BackgroundIntraoperative radiotherapy (IORT) is a new treatment approach for early stage breast cancer. This study reports on the effects of IORT on radiation-related quality of life (QoL) parameters.MethodsTwo hundred and thirty women with stage I-III breast cancer (age, 31 to 84 years) were entered into the study. A single-center subgroup of 87 women from the two arms of the randomized phase III trial TARGIT-A (TARGeted Intra-operative radioTherapy versus whole breast radiotherapy for breast cancer) was analyzed. Furthermore, results were compared to non-randomized control groups: n = 90 receiving IORT as a tumor bed boost followed by external beam whole breast radiotherapy (EBRT) outside of TARGIT-A (IORT-boost), and n = 53 treated with EBRT followed by an external-beam boost (EBRT-boost). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 (QLQ-C30) and BR23 (QLQ-BR23). The mean follow-up period in the TARGIT-A groups was 32 versus 39 months in the non-randomized control groups.ResultsPatients receiving IORT alone reported less general pain (21.3 points), breast (7.0 points) and arm (15.1 points) symptoms, and better role functioning (78.7 points) as patients receiving EBRT (40.9; 19.0; 32.8; and 60.5 points, respectively, P < 0.01). Patients receiving IORT alone also had fewer breast symptoms than TARGIT-A patients receiving IORT followed by EBRT for high risk features on final pathology (IORT-EBRT; 7.0 versus 29.7 points, P < 0.01). There were no significant differences between TARGIT-A patients receiving IORT-EBRT compared to non-randomized IORT-boost or EBRT-boost patients and patients receiving EBRT without a boost.ConclusionsIn the randomized setting, important radiation-related QoL parameters after IORT were superior to EBRT. Non-randomized comparisons showed equivalent parameters in the IORT-EBRT group and the control groups.

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Section: Discussionsupporting

confidence: 89%

Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A

et al. 2013

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“…8 In some studies, low-energy radiographs followed by WBI was associated with double the risk of breast fibrosis (to 37.5%), increased patient-reported pain, and decreased patient-reported quality of life compared with WBI alone. [30][31][32][33] In contrast, other studies have reported outcomes with IORT followed by WBI that appear acceptable and comparable to either WBI alone or WBI with a conventional EBRT boost. [33][34][35] As such, the task force felt the combination of IORT and WBI should be used only with caution and limited to women with higher risk features on final pathology.…”

Section: Adverse Effectsmentioning

confidence: 96%

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

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Harris

Leonardi

et al. 2017

Practical Radiation Oncology

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“…After LEX-IORT as a boost, fibrosis rates are in range with standard treatments [20,21]. Further quality of life is significantly better in LEX-IORT patients in comparison to patients with whole breast radiotherapy [22,23]. Welzel et al showed especially less breast and arm symptoms in LEX-IORT patients during an analysis of the TARGIT A patients in a single center [22].…”

Section: Discussionmentioning

confidence: 99%

A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer

et al. 2014

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BackgroundSince the results from the randomized TARGIT A trial were published, intraoperative radiotherapy (IORT) is used more often. IORT can be provided as accelerated partial breast irradiation (APBI) or as a boost. The definition of suitable patients for IORT as APBI differs between different national societies (e.g. ESTRO and ASTRO) and different inclusion criteria of trials and so does the eligibility of patients. This analysis identifies eligible patients for IORT according to available consensus statements and inclusion criteria of the ongoing TARGIT trials.MethodsBetween 01/03 – 12/09, 1505 breast cancer cases were treated at the breast cancer center at the University Medical Center Mannheim. Complete data sets for age, stage (T, N, and M), histology and hormone receptor status were available in 1108 cases. Parameters to identify eligible patients are as follows: ESTRO: >50 years, invasive ductal carcinoma/other favorable histology (IDC), T1-2 (≤3 cm), N0, any hormone receptor status, M0; ASTRO: ≥60 years, IDC, T1, N0, positive estrogen hormone receptor status, M0; TARGIT E “elderly”, risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology, phase II: ≥70 years, IDC, T1, N0, any hormone receptor status, M0; TARGIT C “consolidation”, risk adapted radiotherapy, phase IV: ≥50 years, IDC, T1, N0, positive hormone receptor status, M0; TARGIT BQR “boost quality registry”: every age, every histology, T1-2 (max. 3.5 cm), any hormone receptor status, N0/+, M0/+.ResultsOut of the 1108 cases, 379 cases (34.2%) were suitable for IORT as APBI regarding the ESTRO and 175 (15.8%) regarding the ASTRO consensus statements. 82 (7.4%) patients were eligible for the TARGIT E trial, 258 (23.3%) for the TARGIT C trial and 671 (60.6%) for the TARGIT BQR registry. According to the consensus statements of ASTRO (45.1%) and ESTRO (41.4%) about half of the eligible patients were treated with IORT as APBI. From the eligible patients fulfilling the criteria for IORT boost (35%) about one third was eventually treated.ConclusionsPatient selection for IORT should be restrictive. For IORT as APBI the TARGIT trials are even more restrictive including patients than the ESTRO and ASTRO consensus statements.

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Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays

Abstract: Patients with early breast cancer after BCS and IORT with or without EBRT present with comparable QoL like patients receiving EBRT without a boost. IORT patients show the lowest rate of breast symptoms.

Cited by 41 publications

References 52 publications

Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A

Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

A cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer

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