WBRT vs. APBI: an interim report of patient satisfaction and outcomes

Abstract

PurposeTo determine differences in patient's reported quality of life and self-reported breast cosmesis between whole breast radiation therapy (WBRT) and accelerated partial breast irradiation (APBI) via single and multi-lumen high-dose-rate (HDR) brachytherapy for women with early stage breast cancer.Material and methodsPatient information was retrospectively reviewed and survey data were prospectively collected for women treated between 2004 to 2014 (APBI) and 2012 to 2014 (WBRT). Criteria for APBI treatments were ER+ (after 2010), N0 (after 2010), T < 3 cm, and post-menopausal. All patients were given a survey with modified FACIT (Functional Assessment of Chronic Illness Therapy) breast quality of life questions to rate their amount of pain, self-consciousness, low energy, presence of lymphedema, and breast cosmesis.Results242 APBI patients and 59 WBRT patients were identified. In the WBRT cohort, 34 women met departmental criteria for APBI treatment (WBRT who were APBI eligible). The FACIT survey was completed by 80 women treated with APBI (33%; mean follow-up time of 14 months), and 26 women treated with WBRT who were APBI eligible (76%; mean follow-up time of 26 months). During the first year post-treatment, low energy (p = 0.009), self-consciousness (p = 0.0004), and lymphedema (p = 0.0002) scores were significantly lower in the APBI cohort when compared to women treated with WBRT who were APBI eligible. During the second year post-treatment, women treated with APBI reported significantly better breast cosmesis (p = 0.04). The single-lumen balloon (score = 6.3/10) was found to be associated with worse cosmesis compared to the multi-lumen balloons (Mammosite ML and Contura; score = 8.2/10; p = 0.002). There were no significant differences in rates of recurrence between balloons or treatments (p > 0.05).ConclusionsAPBI treated patients reported higher cosmetic satisfaction than patients in the matched WBRT cohort. Quality of life scores tended to improve over time. Multi-lumen catheters provided superior cosmetic results compared to single-lumen catheters.

Most patients are eligible for an alternative to conventional whole breast irradiation for early-stage breast cancer: A National Cancer Database Analysis

“…The estimated cost of external beam APBI is $6578 and $13 506 for multifraction intracavitary brachytherapy compared to $13 358 for SWBI . Although the cost of multifraction intracavitary brachytherapy may not be significantly different from SWBI, there is evidence that APBI may offer improvements in social functioning, personal finances, body image, improved energy, cosmetic satisfaction, overall self‐image as well as lower risk of lymphedema compared to SWBI . Recently, Manyam et al utilized the SEER database to evaluate the proportion of patients who would be eligible for APBI and found that 74.6% of women with early‐stage breast cancer would be eligible based on ABS and GEC‐ESTRO guidelines and 41.2% would be eligible based on the 2016 ASTRO guidelines.…”

“…9 Although the cost of multifraction intracavitary brachytherapy may not be significantly different from SWBI, there is evidence that APBI may offer improvements in social functioning, personal finances, body image, improved energy, cosmetic satisfaction, overall self-image as well as lower risk of lymphedema compared to SWBI. 10 | 809…”

Long-Term Results of Partial Breast Irradiation After Breast-Conserving Surgery for Early Stage Breast Cancer: A Prospective Phase II Trial in China

“…The results of 5-year follow-up showed that there was no significant difference between the two groups in IBTR and OS, but APBI-IMRT had significantly better performance in acute and chronic toxicities and cosmetic effects. Bitter et al ( 20 ) enrolled 242 patients with breast cancer and found that the chronic lymphedema, self-confidence, and fatigue in the APBI group were significantly less than those in the WBI group in the 1-year follow-up. In the second year, the cosmetic effects of breast appearance in the APBI group were significantly better than those in the WBI group, and there was no significant difference in the recurrence rate between the two groups.…”

Accelerated partial breast irradiation: Past, present, and future

“…Quality of life is a vital consideration when patients are choosing their breast cancer treatments. Bitter et al[ 53 ] analyzed self-reported cosmetic outcomes for the treated breast and quality of life for patients treated with WBI or APBI via single and multilumen HDR brachytherapy. Two hundred and forty-two patients between 2004 and 2014 with early breast cancer treated with APBI were compared to 59 matched patients treated with WBI from 2012 to 2014.…”