Preoperative radiotherapy (PRT) or radiochemotherapy (PRCT) is used in different tumor sites. The aim of the study was to examine the long-term quality of life (QoL) of localized / locally advanced breast cancer patients treated with PRT/PRCT followed by breast-conserving surgery (BCS) or mastectomy (ME).
Assessment of QoL was done using EORTC QLQ-C30 questionnaires for overall QoL and EORTC QLQ-BR23 for breast-specific QoL. The summary scores were categorized into 4 distinct groups to classify the results. Furthermore, a comparative analysis was performed between the study cohort and a previously published reference cohort of healthy adults. We assessed the impact of different clinical, prognostic, and treatment-related factors on selected items from C30 and BR23 using a dependence analysis.
Out of 315 patients treated with PRT/PCRT in the years 1991 to 1999, 203 patients were alive at long-term follow-up after a mean of 17.7 years (range 14–21). 37 patients were lost to follow-up and 61 patients refused to be contacted, leading to 105 patients (64 patients after BCS and 41 after ME) being willing to undergo further clinical assessment regarding QoL outcome. Overall, QoL (QLQ-C30) was rated “excellent” or “good” in 85% (mean value) of all patients (BCS 83%, ME 88%). Comparative analysis between the study cohort and a published healthy control group revealed significantly better global health status and physical and role functioning scores in the PRT/PRCT group. The analysis demonstrates no differences in nausea/vomiting, dyspnea, insomnia, constipation, or financial difficulties. According to the dependence analysis, global QoL was associated with age, operation type and ME reconstruction.
We did not detect any inferiority of PRT/PRCT compared to a healthy reference group with no hints of a detrimental long-term effect on general and breast-specific quality of life.
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Body mass index
Pathological complete response
Quality of life questionnaire
Quality of life
Statistical analysis system
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Conflict of interest
J. Haussmann, C. Nestle-Kraemling, E. Bölke, S. Wollandt, V. Speer, F.‑J. Djiepmo Njanang, B. Tamaskovics, P.A. Gerber, K. Orth, E. Ruckhaeberle, T. Fehm, S. Corradini, G. Lammering, S. Mohrmann, W. Audretsch, K. Maas, S. Roth, K. Kammers, W. Budach, and C. Matuschek declare that they have no competing interests.
There was no ethics approval necessary, because in this meta-analysis, we were pulling numbers from the published manuscripts and pooling results. The study was approved by the local ethics committee (no.: 4049 and 4070).
The authors Jan Haussmann and Carolin Nestle-Kraemling contributed equally to the manuscript.
The work is a part of the thesis of SW and VS.
Caption Electronic Supplementary Material
Table 6: EORTC QLQ-C30 functional scales between different subgroups. Presented are the mean values of each scale and their corresponding reference group value with confidence intervals. P-values are calculated from two-sided paired t‑tests. Additionally, the rate of excellent and good quality of life summary scales is given for all patients, breast-conserved women, and mastectomy patients.
Table 7: EORTC QLQ-C30 symptom scales between different subgroups. Presented are the mean values of each scale and their corresponding reference group value with confidence intervals. P-values are calculated from two-sided paired t‑tests. Additionally, the rate of excellent and good quality of life summary scales is given for all patients, breast-conserved women, and mastectomy patients.
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Haussmann, J., Nestle-Kraemling, C., Bölke, E. et al. Long-term quality of life after preoperative radiochemotherapy in patients with localized and locally advanced breast cancer. Strahlenther Onkol (2020) doi:10.1007/s00066-019-01557-z
- Neoadjuvant radiochemotherapy
- Cosmetic outcome
- Restrospective study