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Comparison of brachytherapy and external beam radiotherapy boost in breast-conserving therapy: Patient-reported outcome measures and aesthetic outcome

Vergleich von Brachytherapie und perkutaner Boost-Strahlentherapie nach brusterhaltender Therapie: Patientenbewertung und ästhetisches Ergebnis

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Abstract

Objective

This study aimed to estimate the probability of an unfavourable aesthetic outcome (AO) 2 years after breast-conserving therapy (BCT) and evaluate the possible influence of brachytherapy (BT) and external beam radiotherapy (EBRT) boost on patient-reported outcomes (PROs) and AO.

Patients and methods

Patients treated with BCT starting April 2015 were prospectively included. Selection of the boost technique followed an in-house flowchart based on the depth of the tumour bed. An electron boost was performed for a superficial clinical target volume (maximum 28 mm under the epidermis), a BT boost was proposed in all other cases. Patients were followed-up for 2 years. AO was scored by the BCCT.core software and the patient. Further PROs were measured with the EORTC QLQ-C30, QOL-BR23 and the BIBCQ questionnaires.

Results

The analysis included 175 patients, 80 received a BT boost and 95 an EBRT boost. BT patients were significantly older; had a higher breast cup and band size, body mass index and surgical specimen weight of the wide excision; more seroma at baseline and less positive surgical section margins than patients in the EBRT group, and more patients drank alcohol. Cancer- and breast cancer-specific quality of life (QOL) and body image did not differ between the boost techniques over time. Although mean scores for breast symptoms and sexual enjoyment did differ significantly over time (p = 0.05 and < 0.01, respectively), the effect was due to differences before boost administration. Measured with BCCT.core, AO was unfavourable in 28% of patients 2 years after treatment (31% scored by the patient) and results were similar in the BT and EBRT groups.

Conclusion

Using the presented flowchart (See Verhoeven et al. [16]), AO and PROs on QOL or body image up to 2 years after BCT are not influenced by the boost technique.

Zusammenfassung

Zielsetzung

Ziel war es, die Wahrscheinlichkeit eines ungünstigen ästhetischen Ergebnisses (AE) 2 Jahre nach brusterhaltender Therapie (BCT) abzuschätzen sowie den möglichen Einfluss von Brachytherapie (BT) und perkutanem Strahlentherapie(ERBT)-Boost auf patientenberichtete Ergebnisse (PBE) und AE zu beurteilen.

Patienten und Methoden

Prospektiv inkludiert wurden Patientinnen, die ab April 2015 mit BCT behandelt wurden. Die Auswahl der Boost-Technik erfolgte über einen hauseigenen Ablaufplan abhängig von der Tiefe des Tumorbetts. Ein Elektronenboost wurde durchgeführt bei einem oberflächlichen klinischen Zielvolumen (weniger als 29 mm unter der Epidermis), ein BT-Boost bei allen anderen Fällen. Die Patientinnen wurden bis zu 2 Jahre nachbeobachtet. Das AE wurde durch die Patientinnen und die BCCT.core-Software bewertet. Weitere PBE wurden mit dem EORTC QLQ-C30, QOL-BR23 und dem BIBCQ-Fragenbogen gemessen.

Ergebnisse

Die Studie beinhaltete 175 Patientinnen: 80 bekamen einen BT- und 95 einen ERBT-Boost. Patientinnen der BT-Gruppe waren signifikant älter, hatten eine größere Brustgröße, einen größeren Brustumfang, einen größeren Body-Mass-Index, höheres chirurgisches Probengewicht der breiten Exzision, mehr Serom zu Beginn der Analyse, weniger positive Resektionsränder und mehr Alkoholkonsum als die der ERBT-Gruppe. Krebs- oder brustkrebsspezifische Lebensqualität (QOL) und Körperbild unterschieden sich zwischen beiden Boost-Techniken im Zeitverlauf nicht signifikant. Durchschnittswerte für Symptome der Brust und sexuellen Genuss waren im Zeitverlauf zwar signifikant unterschiedlich zwischen beiden Gruppen, waren aber Unterschieden vor Verabreichung des Boosts geschuldet (jeweils p = 0,05 und < 0,01). Gemessen mit BCCT.core war das AE bei 28 % der Patientinnen 2 Jahre nach Behandlung ungünstig (31 % bewertet durch die Patientinnen); die Ergebnisse beider Gruppen waren vergleichbar.

Schlussfolgerung

Unter Verwendung des vorgestellten Ablaufs hat die benutzte Boost-Technik bis zu 2 Jahre nach BCT keinen Einfluss auf AE und PBE im QOL oder Körperbild.

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Funding

This project is realized with the support of Kom op tegen Kanker.

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Authors and Affiliations

  1. Department of Oncology, Experimental Radiation Oncology, KU Leuven—University of Leuven, 3000, Leuven, Belgium

    I. Kindts, M. Christiaens, H. Janssen, E. Van Limbergen & C. Weltens

  2. Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    I. Kindts, M. Christiaens, H. Janssen, E. Van Limbergen & C. Weltens

  3. Leuven Biostatistics and Statistical Bioinformatics Centre (L-Biostat), KU Leuven University, Kapucijnenvoer 35, 3000, Leuven, Belgium

    A. Laenen

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  1. I. Kindts
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Correspondence to I. Kindts.

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Conflict of interest

I. Kindts, A. Laenen, M. Christiaens, H. Janssen, E. VanLimbergen and C. Weltens declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Kindts, I., Laenen, A., Christiaens, M. et al. Comparison of brachytherapy and external beam radiotherapy boost in breast-conserving therapy: Patient-reported outcome measures and aesthetic outcome. Strahlenther Onkol 195, 21–31 (2019). https://doi.org/10.1007/s00066-018-1346-7

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