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Predictive factors for persistent and late radiation complications in breast cancer survivors

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Abstract

Purpose

With improved diagnostic techniques and treatments of breast cancer, overall survival times are longer, giving more opportunity for normal tissue complications of treatment to manifest. Radiation late effects (RLEs) could have profound long-term impacts on the quality of life of the survivors. The aim of this study was to identify predictive factors influencing timing and types of complications in patients referred to the Adult Radiation Late Effects Clinic (ARLEC).

Methods

In a period of 16 years, 296 breast cancer patients were referred to the ARLEC. The clinical records were retrospectively studied to collect epidemiologic, medical and treatment data. Associations were sought between candidate predictive factors and time to the first complication after radiation treatment (RT) completion (primary outcome), and pain or swelling (secondary outcomes) using univariable and multivariable linear and logistic regression analyses. All analyses were performed in SAS, version 9.4.

Results

All patients were female with a mean age of 56.3 years. The first treatment-related complication occurred after a median of 3 months. Patients were followed at ARLEC for a median of 18 months. Older age and delay from surgery to RT (S-RT delay) were associated with earlier onset of complications (both p < 0.001). The most common complications were breast pain (62.1%) and swelling (45.9%). Histology and RT boost were associated with pain (p = 0.035 and 0.013). RT boost and S-RT delay on the other hand were associated with swelling (p = 0.013 and 0.005).

Conclusions

Clinical factors identified could help recognize the patients at high risk for developing RLEs and alert physicians to initiate earlier diagnostic and therapeutic measures.

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Acknowledgements

The authors would like to thank Dr. Andrea Bezjak for her guidance and support; Dr. Heather McCarthy for her pilot study on ARLEC data; Ms. Arlyn Cabradilla, former clinical research intern; Ms. Sameera Ahmed, REDCap coordinator and Ms. Anthea Lau, data analyst for their valuable assistance. The authors would also like to thank Princess Margaret Cancer Foundation and Clinical Cancer Research Unit for their support.

Funding

This study was funded by the Princess Margaret Cancer Foundation, through Agnico-Eagle Research Fund (award number FCC 886471001147).

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Authors and Affiliations

  1. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada

    F. Fekrmandi, J. Helou & W. Levin

  2. Biostatistics Department, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada

    T. Panzarella

  3. Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Canada

    R. E. Dinniwell

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  1. F. Fekrmandi
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Correspondence to W. Levin.

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This study was in accordance with the ethical standards of 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the University Health Network Research Ethics Board.

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Fekrmandi, F., Panzarella, T., Dinniwell, R.E. et al. Predictive factors for persistent and late radiation complications in breast cancer survivors. Clin Transl Oncol 22, 360–369 (2020). https://doi.org/10.1007/s12094-019-02133-8

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