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

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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.

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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

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Author information

Authors and Affiliations

  1. Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany

    Jan Haussmann, Edwin Bölke, Vanessa Speer, Freddy-Joel Djiepmo Njanang, Bálint Tamaskovics, Kitti Maas, Stephan Roth, Wilfried Budach & Christiane Matuschek

  2. Heinrich Heine University, Department of Gynecologic and Obstetrics, EVK Dusseldorf, Dusseldorf, Germany

    Carolin Nestle-Kraemling

  3. Department of Senology, Sana Kliniken Dusseldorf, Dusseldorf, Germany

    Sylvia Wollandt

  4. Department of Dermatology, Medical Faculty, Heinrich Heine University Dusseldorf, Dusseldorf, Germany

    Peter Arne Gerber

  5. Department of General, Visceral and Thoracic Surgery, Harzkliniken Goslar, Goslar, Germany

    Klaus Orth

  6. Department of Senology and Breast Surgery, Marienhospital Dusseldorf, Dusseldorf, Germany

    Werner Audretsch

  7. Division of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Kai Kammers

  8. Department of Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany

    Eugen Ruckhaeberle, Tanja Fehm & Svjetlana Mohrmann

  9. Department of Radiation Oncology, LMU University of Munich, Munich, Germany

    Stefanie Corradini

  10. Radiotherapy Institute Bergisch Gladbach, Gladbach, Germany

    Guido Lammering

Authors
  1. Jan Haussmann
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  2. Carolin Nestle-Kraemling
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  8. Peter Arne Gerber
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Contributions

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.

Corresponding author

Correspondence to Edwin Bölke.

Ethics declarations

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).

Additional information

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

66_2019_1557_MOESM1_ESM.doc

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

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

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

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 196, 386–397 (2020). https://doi.org/10.1007/s00066-019-01557-z

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