Long-term quality of life after preoperative radiochemotherapy in patients with localized and locally advanced breast cancer
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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.
KeywordsNeoadjuvant radiochemotherapy Cosmetic outcome Questionnaire Restrospective study Evaluation
Body mass index
Pathological complete response
Quality of life questionnaire
Quality of life
Statistical analysis system
CM, CNK, EB, and WB had the idea, coordinated the work, and wrote parts of the manuscript. JH did the literature research, prepared the data for analysis, and wrote parts of the manuscript. KK and JH did the statistical analysis. SW, VS, FJN, BZ, PAG, KO, ER, TF, SC, GL, SM, and SR wrote parts of the manuscript. WA operated all patients. JH contributed significantly to the discussion on the interpretation of the results. CM, JH, and PAG prepared the figures and tables. All authors read and approved the final manuscript. All authors gave consent for the publication.
Compliance with ethical guidelines
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).
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