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Long-term quality of life after preoperative radiochemotherapy in patients with localized and locally advanced breast cancer

  • Jan Haussmann
  • Carolin Nestle-Kraemling
  • Edwin BölkeEmail author
  • Sylvia Wollandt
  • Vanessa Speer
  • Freddy-Joel Djiepmo Njanang
  • Bálint Tamaskovics
  • Peter Arne Gerber
  • Klaus Orth
  • Eugen Ruckhaeberle
  • Tanja Fehm
  • Stefanie Corradini
  • Guido Lammering
  • Svjetlana Mohrmann
  • Werner Audretsch
  • Kitti Maas
  • Stephan Roth
  • Kai Kammers
  • Wilfried Budach
  • Christiane Matuschek
Original Article
  • 35 Downloads

Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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.

Keywords

Neoadjuvant radiochemotherapy Cosmetic outcome Questionnaire Restrospective study Evaluation 

Abbreviations

BCS

Breast-conserving surgery

BCT

Breast-conserving treatment

BMI

Body mass index

CI

Confidence interval

DFS

Disease-free survival

FU

Follow-up

HR

Hazard ratio

ME

Mastectomy

n.v.

No value

n

Number

OS

Overall survival

pCR

Pathological complete response

PCRT

Preoperative radiochemotherapy

QLQ

Quality of life questionnaire

QoL

Quality of life

RR

Risk ratio

RT

Radiotherapy

SAS

Statistical analysis system

w

With

w/o

Without

Notes

Author Contribution

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.

Ethical standards

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).

Supplementary material

66_2019_1557_MOESM1_ESM.doc (50 kb)
Table 5a: Patient characteristics of breast-conserving surgery. Median follow-up is 16.6 years. The comparison between the original neoadjuvant group and the current cohort is presented.
66_2019_1557_MOESM2_ESM.doc (50 kb)
Table 5b: Patient characteristics of mastectomy. Median follow-up is 17.2 years. The comparison between the original neoadjuvant group and the current cohort is shown.
66_2019_1557_MOESM3_ESM.pptx (54 kb)
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.
66_2019_1557_MOESM4_ESM.pptx (57 kb)
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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Jan Haussmann
    • 1
  • Carolin Nestle-Kraemling
    • 2
  • Edwin Bölke
    • 1
    Email author
  • Sylvia Wollandt
    • 3
  • Vanessa Speer
    • 1
  • Freddy-Joel Djiepmo Njanang
    • 1
  • Bálint Tamaskovics
    • 1
  • Peter Arne Gerber
    • 4
  • Klaus Orth
    • 5
  • Eugen Ruckhaeberle
    • 8
  • Tanja Fehm
    • 8
  • Stefanie Corradini
    • 9
  • Guido Lammering
    • 10
  • Svjetlana Mohrmann
    • 8
  • Werner Audretsch
    • 6
  • Kitti Maas
    • 1
  • Stephan Roth
    • 1
  • Kai Kammers
    • 7
  • Wilfried Budach
    • 1
  • Christiane Matuschek
    • 1
  1. 1.Medical Faculty, Department of Radiation OncologyHeinrich Heine UniversityDusseldorfGermany
  2. 2.Heinrich Heine UniversityDepartment of Gynecologic and Obstetrics, EVK DusseldorfDusseldorfGermany
  3. 3.Department of SenologySana Kliniken DusseldorfDusseldorfGermany
  4. 4.Department of Dermatology, Medical FacultyHeinrich Heine University DusseldorfDusseldorfGermany
  5. 5.Department of General, Visceral and Thoracic SurgeryHarzkliniken GoslarGoslarGermany
  6. 6.Department of Senology and Breast SurgeryMarienhospital DusseldorfDusseldorfGermany
  7. 7.Division of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsThe Johns Hopkins University School of MedicineBaltimoreUSA
  8. 8.Department of GynecologyHeinrich Heine University DüsseldorfDusseldorfGermany
  9. 9.Department of Radiation OncologyLMU University of MunichMunichGermany
  10. 10.Radiotherapy Institute Bergisch GladbachGladbachGermany

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