Mukesh B Mukesh1, Wendi Qian2, Jennifer S Wilkinson3, Leila Dorling4, Gillian C Barnett5, Anne M Moody3, Charles Wilson3, Nicola Twyman3, Neil G Burnet6, Gordon C Wishart7, Charlotte E Coles3. 1. Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK; Department of Oncology, Colchester Hospital University NHS Foundation Trust, Essex, UK. Electronic address: drmukesh1980@doctors.net.uk. 2. Cambridge Cancer Trials Centre, Cambridge Clinical Trials Unit - Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Medical Research Council, Biostatistics Unit Hub for Trials Methodology, UK. 3. Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK. 4. Cancer Research-UK Centre for Genetic Epidemiology & Dept of Oncology, University of Cambridge, Strangeways Research Laboratory, UK. 5. Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK; Cancer Research-UK Centre for Genetic Epidemiology & Dept of Oncology, University of Cambridge, Strangeways Research Laboratory, UK. 6. University of Cambridge, Department of Oncology, Oncology Centre, Addenbrooke's Hospital, UK. 7. Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK.
Abstract
BACKGROUND: The use of intensity-modulated radiotherapy (IMRT) in breast cancer reduces clinician-assessed breast tissue toxicity including fibrosis, telangectasia and sub-optimal cosmesis. Patient reported outcome measures (PROMs) are also important as they provide the patient's perspective. This longitudinal study reports on (a) the effect of forward planned field-in-field IMRT (∼simple IMRT) on PROMs compared to standard RT at 5 years after RT, (b) factors affecting PROMs at 5years after RT and (c) the trend of PROMs over 5 years of follow up. METHODS: PROMs were assessed at baseline (pre-RT), 6, 24 and 60 months after completion of RT using global health (EORTC QLQ C30) and 4 breast symptom questions (BR23). Also, 4 breast RT-specific questions were included at 6, 24 and 60 months: change in skin appearance, firmness to touch, reduction in breast size and overall change in breast appearance since RT. The benefits of simple IMRT over standard RT at 5 years after RT were assessed using standard t-test for global health and logistic regression analysis for breast symptom questions and breast RT-specific questions. Clinical factors affecting PROMs at 5 years were investigated using a multivariate analysis. A repeated mixed model was applied to explore the trend over time for each of PROMs. RESULTS: (89%) 727/815, 84%, 81% and 61% patients completed questionnaires at baseline, 6, 24 and 60 months respectively. Patients reported worse toxicity for all four BR23 breast symptoms at 6 months, which then improved over time (p<0.0001). They also reported improvement in skin appearance and breast hardness over time (p<0.0001), with no significant change for breast shrinkage (p=0.47) and overall breast appearance (p=0.13). At 5years, PROMs assessments did not demonstrate a benefit for simple IMRT over standard radiotherapy. Large breast volume, young age, baseline surgical cosmesis and post-operative infection were the most important variables to affect PROMs. CONCLUSIONS: This study was unable to demonstrate the benefits of IMRT on PROMs at 5years. PROMs are influenced by non-radiotherapy factors and surgical factors should be optimised to improve patients' outcome. Only a small proportion of patients report moderate-severe breast changes post radiotherapy, with most PROMs improving over time. The difference in clinician assessment and PROMs outcome requires further investigation. Crown
BACKGROUND: The use of intensity-modulated radiotherapy (IMRT) in breast cancer reduces clinician-assessed breast tissue toxicity including fibrosis, telangectasia and sub-optimal cosmesis. Patient reported outcome measures (PROMs) are also important as they provide the patient's perspective. This longitudinal study reports on (a) the effect of forward planned field-in-field IMRT (∼simple IMRT) on PROMs compared to standard RT at 5 years after RT, (b) factors affecting PROMs at 5years after RT and (c) the trend of PROMs over 5 years of follow up. METHODS: PROMs were assessed at baseline (pre-RT), 6, 24 and 60 months after completion of RT using global health (EORTC QLQ C30) and 4 breast symptom questions (BR23). Also, 4 breast RT-specific questions were included at 6, 24 and 60 months: change in skin appearance, firmness to touch, reduction in breast size and overall change in breast appearance since RT. The benefits of simple IMRT over standard RT at 5 years after RT were assessed using standard t-test for global health and logistic regression analysis for breast symptom questions and breast RT-specific questions. Clinical factors affecting PROMs at 5 years were investigated using a multivariate analysis. A repeated mixed model was applied to explore the trend over time for each of PROMs. RESULTS: (89%) 727/815, 84%, 81% and 61% patients completed questionnaires at baseline, 6, 24 and 60 months respectively. Patients reported worse toxicity for all four BR23 breast symptoms at 6 months, which then improved over time (p<0.0001). They also reported improvement in skin appearance and breast hardness over time (p<0.0001), with no significant change for breast shrinkage (p=0.47) and overall breast appearance (p=0.13). At 5years, PROMs assessments did not demonstrate a benefit for simple IMRT over standard radiotherapy. Large breast volume, young age, baseline surgical cosmesis and post-operative infection were the most important variables to affect PROMs. CONCLUSIONS: This study was unable to demonstrate the benefits of IMRT on PROMs at 5years. PROMs are influenced by non-radiotherapy factors and surgical factors should be optimised to improve patients' outcome. Only a small proportion of patients report moderate-severe breast changes post radiotherapy, with most PROMs improving over time. The difference in clinician assessment and PROMs outcome requires further investigation. Crown
Authors: Julius K Weng; Xiudong Lei; Pamela Schlembach; Elizabeth S Bloom; Simona F Shaitelman; Isidora Y Arzu; Gregory Chronowski; Tomas Dvorak; Emily Grade; Karen Hoffman; George Perkins; Valerie K Reed; Shalin J Shah; Michael C Stauder; Eric A Strom; Welela Tereffe; Wendy A Woodward; Gabriel N Hortobagyi; Kelly K Hunt; Thomas A Buchholz; Benjamin D Smith Journal: Int J Radiat Oncol Biol Phys Date: 2021-05-13 Impact factor: 8.013
Authors: Milly Buwenge; Silvia Cammelli; Ilario Ammendolia; Giorgio Tolento; Alice Zamagni; Alessandra Arcelli; Gabriella Macchia; Francesco Deodato; Savino Cilla; Alessio G Morganti Journal: Breast Cancer (Dove Med Press) Date: 2017-03-06
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