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Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays

  • American Society of Breast Surgeons
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Abstract

Background

Intraoperative radiotherapy (IORT) is currently being evaluated as a novel approach during breast-conserving surgery (BCS). IORT can be used either as a tumor bed boost followed by external-beam radiotherapy (EBRT) or as a single treatment. In a matched-pair study, we assessed quality of life (QoL) in 69 patients with early breast cancer treated with BCS and/or IORT and/or EBRT.

Methods

Patients were matched for age and time since BCS. IORT was provided with 50 kV x-rays (Intrabeam) delivering 20 Gy at the applicator surface. EBRT (46 to 50 Gy in 2-Gy fractions in the IORT with EBRT group, and 56 Gy in 2-Gy fractions in the EBRT group) was initiated after completion of wound healing and/or chemotherapy. The mailed questionnaires included the European Organization for the Research and Treatment of Cancer QLQ-C30 and BR23, FACT-F, HADS, Body Image Scale, and Rosenberg Self-Esteem Scale. At 18 to 70 months’ follow-up (median 47 months), all patients were disease free.

Results

We found only a few differences between the three groups. There was a trend toward more pain (mean ± standard deviation; 42.8 ± 32.9 vs. 27.5 ± 34.7) and reduced QoL (57.6 ± 20.7 vs. 70.3 ± 23.9) after IORT with EBRT compared with EBRT, respectively. IORT patients reported comparable QoL (70.3 ± 23.0), and less breast symptoms and body image concerns compared to EBRT (8.6 ± 12.3 vs. 19.2 ± 23.8, and 1.7 ± 3.3 vs. 3.4 ± 4.4, respectively). IORT alone resulted in significantly fewer breast symptoms (8.6 ± 12.3; P = 0.012) and less pain (23.9 ± 24.5, P = 0.041) compared with IORT with EBRT (26.1 ± 27.6; 42.8 ± 32.9, respectively).

Conclusions

Patients with early breast cancer after BCS and IORT with or without EBRT present with comparable QoL like patients receiving EBRT without a boost. IORT patients show the lowest rate of breast symptoms.

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Acknowledgment

The project is supported by Grant FKZ 01ZP0508 from the BMBF.

Conflict of interest

Grit Welzel, Frank Hofmann, Elena Blank, Uta Kraus-Tiefenbacher, Brigitte Hermann, and Marc Sütterlin state that they have no competing interests. Frederik Wenz received funding for radiobiology research from Carl Zeiss Surgical, Oberkochen, Germany.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, Mannheim, Germany

    Grit Welzel, Frank Hofmann, Elena Blank, Uta Kraus-Tiefenbacher, Brigitte Hermann & Frederik Wenz

  2. Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

    Marc Sütterlin

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  1. Grit Welzel
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  2. Frank Hofmann
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Correspondence to Grit Welzel.

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Welzel, G., Hofmann, F., Blank, E. et al. Health-Related Quality of Life After Breast-Conserving Surgery and Intraoperative Radiotherapy for Breast Cancer Using Low-Kilovoltage X-rays. Ann Surg Oncol 17 (Suppl 3), 359–367 (2010). https://doi.org/10.1245/s10434-010-1257-z

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