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

Abstract

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.

An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial)

“…This was not negated by the EBRT boost delivered to 15% of the TARGIT arm patients; toxicity was the same whether such an EBRT boost was applied to TARGIT or EBRT patients. 107 There were significantly fewer grade 3 or 4 radiotherapy-related complications in the TARGIT arm; however, one should note that the incidence of these complications was very low in both arms of the trial. This, and the low local recurrence rate reported, is a testament to the high-quality radiotherapy given in the EBRT arm.…”

“…107,109,110 Mortality Although the number of breast cancer deaths did not differ significantly between groups, there were significantly fewer deaths from other causes in the TARGIT arm of the trial (number of deaths from causes other than breast cancer: TARGIT 17, EBRT 35). In particular, there were far fewer deaths from cancers other than breast cancer (TARGIT 8 vs. 16) or from cardiovascular disease (EBRT 2 vs. 11).…”

“…Even among those who have a lumpectomy, TARGIT causes less pain, higher levels of patient satisfaction and higher quality-of-life scores than conventional radiotherapy. 107 There is a significant improvement in a woman's cancer journey when the whole of local treatment is completed at the time of the cancer operation, rather than having a daily 3-to 6-week commute to the cancer hospital. TARGIT patients also have half the risk of dying from heart disease or other cancers than those undergoing EBRT.…”

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

“…[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.…”

Psychological distress in patients with breast cancer after different antitumor treatments

“…Причем, как отмечают авторы [25], качество жизни, связанное со здоровьем, выше у больных, перенесших интраоперационную лучевую терапию, по сравнению с перенесшими дистанцион-ную лучевую терапию. Проведенное с помощью Госпи-тальной шкалы тревоги и депрессии психологическое исследование 323 пациенток с РМЖ, получавших про-тивоопухолевое лечение, позволило выделить подгруп-пу из 8 % больных, у которых на фоне проводимой химиотерапии отмечались высокие показатели ди-стресса на протяжении 8 мес после постановки диаг-ноза [7].…”