Catheter-Based Accelerated Partial Breast Brachytherapy Results in Excellent Patient-Reported Quality of Life

Abstract

Accelerated partial breast irradiation (APBI) and whole breast radiotherapy (WBR) are treatment options for early stage breast cancer. The purpose of this study was to compare patient-reported-outcomes (PRO) between patients receiving APBI or WBR. 197 chronologically matched patients (pts) with low risk, early stage breast cancer were treated with either APBI or WBR between October 2012 and May 2015. The Linear Analog 10-point Scales (LASA), Breast Cancer Treatment Outcome Scale (BCTOS), and Harvard Breast Cosmesis Scale (HBCS) were used to assess overall quality of life (LASA), pain (LASA, BCTOS), fatigue (LASA), perceived aesthetic and functional status (BCTOS, LASA), and breast cosmesis (BCTOS, HBCS). Comparisons of PROs between treatment groups were performed using Fisher exact test, chi-square, Wilcoxon rank-sum, and regression methods. Survey compliance was 66% (64 APBI and 67 WBR pts). Median follow-up was 13.3 months, with a mean interval between the last fraction and survey completion of 15.4 v 14.2 months (p=0.58), for the APBI and WBR groups, respectively. The majority of respondents had grade 1-2 (86%), T1 (92%), and N0 (93%) in-situ or invasive ductal carcinoma. Pts treated with WBR were more likely to be younger (median 65 v 69 yrs, p=0.02), have T2 tumors (15% v 2%, p=0.01), and to receive chemotherapy (21% v 2%, p<0.001). In the WBR group, the median dose delivered was 42.56 Gy in 16 fractions, with 54% of pts receiving a lumpectomy cavity boost (median dose 10 Gy). In the APBI group, the median dose delivered was 34 Gy in 10 twice daily fractions utilizing an intraoperatively-placed high dose rate brachytherapy applicator. There was no difference in overall quality of life (8.5 v 8.9, p=0.14), pain (2.1 v 2.1, p=0.21) or fatigue (3.0 v 3.0, p=0.21) between the APBI and WBR groups, respectively. The mean overall BCTOS (31.6 v 34.3, p=0.52) was similar between groups, as was the BCTOS overall cosmetic status, and individual cosmetic measures including breast size, nipple appearance, breast shape, and breast heaviness (all p>0.05). Individual BCTOS functional measures, including arm heaviness, breast/arm swelling, arm/shoulder range of motion, and joint stiffness were similar between groups, all p>0.05. A higher proportion of pts receiving WBR reported breast elevation (slight: 33% v 16%, moderate: 25% v 8%, p=0.01). Skin color change relative to baseline was also more common in the WBR group (p=0.01), with a trend towards greater telangiectasia formation (p=0.053). For the APBI and WBR groups, most pts reported excellent (48% v 54%) or good (41 v 40%) cosmesis, with no difference between groups (p=0.37). APBI and WBR are associated with excellent and comparable 1-year PROs. In this sample, APBI resulted in a lesser degree of patient-reported breast elevation and skin color change relative to baseline.