Long Term Patient Reported Quality of Life Outcomes and Patient Satisfaction of 1-Week Hypofractionated Whole Breast Radiation Therapy Using IMRT for Early-Stage Breast Cancer

Abstract

Novel whole breast radiation therapy (WBRT) regimens have been recently reported with the aim of improving patient convenience while preserving local control and breast cosmesis. The UK FAST Forward trial showed that 26 Gy in 5 fx using 3D conformal WBRT was equivalent to the standard 3-week regimen. However, the use of inverse planned intensity modulated radiation therapy (IMRT) for this novel ultra-hypofractionated regimen has not been previously studied. We aim to study the patient reported quality of life (QOL) outcomes and patient satisfaction of WBRT using IMRT delivering 26 Gy in 5 fractions. Patients receiving WBRT with 26 Gy in 5 fractions using IMRT at our institution from 2020 to 2022 were included. Patients were treated with 26 Gy in 5 daily fx with or without a single fx boost of 4-5.2 Gy. IMRT plans were generated using inverse planning with 2 to 3 volumetric modulated arcs (VMAT). To assess patient-reported QOL outcomes, a questionnaire was prospectively administered at 1 month post treatment and yearly thereafter including the EORTC QLQ-BR23 breast cancer module and other patient satisfaction questions. Patient assessment involved a four-point scale (not at all, a little, quite a bit, and very much; very satisfied, moderately satisfied, moderately dissatisfied, and very dissatisfied). Here, we report the 1-year patient reported acute toxicity QOL outcomes and patient satisfaction for those undergoing IMRT based WBRT. Cross-sectional analyses were used to determine the prevalence of "quite a bit" or "very much" effects versus "not at all" or "a little" effects. A total of 96 patients were included. The median age at diagnosis was 65 years. The most common histology was invasive ductal carcinoma (53.1%). ER-positivity was found in 75.5% patients. Oncoplastic reconstruction was used in 51.0% patients. The median tumor size was 1.5 cm. There were 4/98 (4.3%) node positive patients and 22.5% received adjuvant chemotherapy. Endocrine therapy was used in 74.5% patients. A boost fraction was delivered in 95.9% patients. At the 1-year assessment, only 1/35 (2.9%), 2/35 (5.7%), and 4/35 (11.4%) patients reported "quite a bit" or "very much" breast pain, skin problems, and changes in breast appearance respectively. Additionally, 32/35 (91.4%) patients were either "very satisfied" or "moderately satisfied" with their treatment, while 32/35 (91.4%) patients reported "excellent" (n = 12) or "good" (n = 20) physical appearance of the breast. WBRT using inverse planned IMRT with 26 Gy in 5 fx shows excellent patient reported QOL and patient satisfaction at 1-year post RT. Longer follow up is needed to assess the long-term toxicity, normal tissue effects, and cosmetic outcomes of IMRT based delivery of this ultra-hypofractionated regimen.