The quality of life of women treated with a targeted form of radiation therapy, called accelerated partial breast irradiation (APBI), is similar to those who get the standard whole-breast radiation therapy, results from a Phase 3 trial show.
This makes it a good option for women with early breast cancer after they undergo breast-conserving surgery since APBI treatment takes less than a week, instead of the three to six weeks required for the traditional radiotherapy.
The study, “Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5-year results of a randomised, phase 3 trial,” was published in the journal The Lancet Oncology.
APBI uses small tubes to deliver a high dose of radiation directly into the tumor site over a short period of time.
“This treatment focuses only on the area of the breast where the tumor has been removed and so it offers a number of advantages. It allows us to deliver a higher dose of radiation to a smaller area, which means the course of treatment is shortened from three to six weeks down to one week or less. It also makes it easier to avoid unnecessary radiation to other parts of the body, such as the heart and lungs,” Rebekka Schäfer, MD, a clinician in the department of radiation oncology at University Hospital Würzburg in Germany and the study’s first author, said in a press release.
The trial, called GEC-ESTRO (NCT00402519), enrolled 1,328 women with early breast cancer, defined as stage zero to 2a, who had received breast-conserving surgery in 16 hospitals and medical centers across seven European countries.
After surgery, 551 participants were randomly assigned whole-breast radiotherapy, and 633 to APBI using multicatheter brachytherapy. While those in the whole-breast radiotherapy group received treatment for six weeks, the ABPI group underwent radiation therapy for just four to five days.
Investigators had already reported that APBI using multicatheter brachytherapy led to similar five-year overall survival and progression-free survival rates as whole-breast radiotherapy.
“However, compared to external radiotherapy this is a more invasive treatment, so we wanted to see how it affected women’s quality of life and their symptoms, both when they are treated and in the longer term,” Schäfer said.
Quality of life — a predetermined secondary measure of the trial — was assessed through patient-reported quality-of-life questionnaires answered at different stages: before radiotherapy, immediately after radiotherapy, and during follow-up at three months and again at five years after treatment.
The results showed that quality of life was equally good for women in both groups and was maintained at the five-year follow-up.
“The only moderate, significant difference (difference of 10–20 points) between the groups was found in the breast symptoms scale,” the researchers wrote in the study.
In fact, patients treated with whole-breast irradiation had significantly worse symptoms — breast swelling and pain, and skin problems — than the APBI group immediately after radiotherapy and at the three-month follow-up.
“More and more women are surviving breast cancer for longer and longer, so we need to be sure that treatments do not detract from their quality of life in the long term,” Schäfer said.
“Research like this is vital because it allows us to offer treatment choices. For a variety of reasons patients may find it difficult to manage a treatment schedule that lasts up to six weeks. They may have to travel a long way to reach hospital, or they may wish to return to work as soon as possible, so they might prefer a treatment that can be carried out in a week or less,” she said.
Researchers now plan to follow up with the women at 10 years post-treatment to determine if quality of life is still maintained in the long term. They’ll also evaluate if there are differences in cancer recurrence rates between the two treatments.
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