title: Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life.
abstract: Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type.
  
  
  
  We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤3.0 cm and lymph node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 "not at all" to 5 "all the time") and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors.
  
  
  
  Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up.
  
  
  
  Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA. mperez@dom.wustl.edu.
authors.forename: M
authors.identifier: 0000-0002-2809-2504
authors.initials: M
authors.lastname: Pérez
authors.affiliation: Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA.|Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: M
authors.initials: M
authors.lastname: Schootman
authors.affiliation: Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA.|Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Hall
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.|Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: D B
authors.initials: DB
authors.lastname: Jeffe
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011788:Quality of Life; D011855:Radiodermatitis / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods*; D012871:Skin Diseases / Q000209:etiology; D016896:Treatment Outcome
keywords: Accelerated treatments; Breast cancer; Quality of life; Radiation therapy; Side effects