Five-Year Longitudinal Analysis of Patient-Reported Outcomes and Cosmesis in a Randomized Trial of Conventionally Fractionated Versus Hypofractionated Whole-Breast Irradiation.
Five-Year Longitudinal Analysis of Patient-Reported Outcomes and Cosmesis in a Randomized Trial of Conventionally Fractionated Versus Hypofractionated Whole-Breast Irradiation.
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DOI：
10.1016/j.ijrobp.2021.05.004
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发表时间：
2021-10-01
影响因子：
7
通讯作者：
Smith, Benjamin D.
中科院分区：
文献类型：
--
作者：
Weng, Julius K.;Lei, Xiudong;Schlembach, Pamela;Bloom, Elizabeth S.;Shaitelman, Simona F.;Arzu, Isidora Y.;Chronowski, Gregory;Dvorak, Tomas;Grade, Emily;Hoffman, Karen;Perkins, George;Reed, Valerie K.;Shah, Shalin J.;Stauder, Michael C.;Strom, Eric A.;Tereffe, Welela;Woodward, Wendy A.;Hortobagyi, Gabriel N.;Hunt, Kelly K.;Buchholz, Thomas A.;Smith, Benjamin D.
关于全乳照射（WBI）加加强治疗后患者报告结局（PRO）的预测因素的前瞻性数据有限。我们试图在一项比较常规分割（CF）与大分割（HF）WBI的随机试验中描述纵向PRO和美观。从2011年至2014年，年龄≥40岁的Tis-T2 N 0-N1 a M0乳腺癌女性接受了肿瘤切除术，切缘阴性，随机接受CF-WBI（50 Gray [戈伊]/25次+加强）与HF-WBI（42.56戈伊/16次+加强）。在基线（放疗前）、6个月和此后每年直至5年，PRO包括乳腺癌治疗结局量表（BCTOS）、癌症治疗功能评估-乳腺（FACTB）和身体形象量表;由主治医生使用放射治疗肿瘤组美容值报告美容。多变量混合效应生长曲线模型评估了治疗组和患者因素与结局的相关性，并检测了与治疗组的相关相互作用。共有287例患者接受了随机分组，共完成了14，801项PRO评估。中位年龄为60岁，37%的患者胸罩罩杯尺寸≥D，44%肥胖，30%接受化疗。5年内，不同治疗组的PRO或美容效果无显著差异。胸罩罩杯尺寸≥D与BCTOS美容效果（P <0.001）、BCTOS疼痛（P = 0.001）、FACT-B试验结局指数（P = 0.03）、FACT-B情绪健康（P = 0.03）和身体形象量表（P = 0.003）评分较差相关。超重（P = 0.02）或肥胖（P <0.001）患者的医生评定美容效果较差。使用CF-WBI的患者亚组均未获得更好的PRO或美容效果。CF-WBI和HF-WBI在5年随访期间的纵向PRO和医生评定的美容效果相似，没有相关子集的表现优于CF-WBI。这一证据支持广泛采用低分割联合加强治疗，包括接受化疗的患者和肥胖患病率高的人群。大乳房大小和肥胖与多个领域不良结局的相关性突出了让高危患者参与生活方式干预策略以及考虑替代放射治疗方案的机会。
There are limited prospective data on predictors of patient-reported outcomes (PROs) after whole-breast irradiation (WBI) plus a boost. We sought to characterize longitudinal PROs and cosmesis in a randomized trial comparing conventionally fractionated (CF) versus hypofractionated (HF) WBI. From 2011 to 2014, women aged ≥40 years with Tis-T2 N0-N1a M0 breast cancer who underwent a lumpectomy with negative margins were randomized to CF-WBI (50 Gray [Gy]/25 fractions plus boost) versus HF-WBI (42.56 Gy/16 fractions plus boost). At baseline (pre-radiation), at 6 months, and yearly thereafter through 5 years, PROs included the Breast Cancer Treatment Outcome Scale (BCTOS), Functional Assessment of Cancer Therapy−Breast (FACTB), and Body Image Scale; cosmesis was reported by the treating physician using Radiation Therapy Oncology Group cosmesis values. Multivariable mixed-effects growth curve models evaluated associations of the treatment arm and patient factors with outcomes and tested for relevant interactions with the treatment arm. A total of 287 patients were randomized, completing a total of 14,801 PRO assessments. The median age was 60 years, 37% of patients had a bra cup size ≥D, 44% were obese, and 30% received chemotherapy. Through 5 years, there were no significant differences in PROs or cosmesis by treatment arm. A bra cup size ≥D was associated with worse BCTOS cosmesis (P < .001), BCTOS pain (P = .001), FACT-B Trial Outcome Index (P = .03), FACT-B Emotional Well-being (P = .03), and Body Image Scale (P = .003) scores. Physician-rated cosmesis was worse in patients who were overweight (P = .02) or obese (P < .001). No patient subsets experienced better PROs or cosmesis with CF-WBI. Both CF-WBI and HF-WBI confer similar longitudinal PROs and physician-rated cosmesis through 5 years of follow-up, with no relevant subsets that fared better with CF-WBI. This evidence supports broad adoption of hypofractionation with boost, including in patients receiving chemotherapy and in a population with a high prevalence of obesity. The associations of large breast size and obesity with adverse outcomes across multiple domains highlight the opportunity to engage at-risk patients in lifestyle intervention strategies, as well as to consider alternative radiation treatment regimens.
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DOI：
10.1093/annonc/mdu042
发表时间：
2014-10
期刊：
Annals of oncology : official journal of the European Society for Medical Oncology
影响因子：
--
作者：
Chan DSM;Vieira AR;Aune D;Bandera EV;Greenwood DC;McTiernan A;Navarro Rosenblatt D;Thune I;Vieira R;Norat T
通讯作者：
Norat T
影响因子：
3.8
作者：
Di Micco, R.;O'Connell, R. L.;Rusby, J. E.
通讯作者：
Rusby, J. E.
影响因子：
45.3
作者：
Meattini, Icro;Marrazzo, Livia;Livi, Lorenzo
通讯作者：
Livi, Lorenzo
影响因子：
8.4
作者：
Hopwood, P;Fletcher, I;Ghazal, SA
通讯作者：
Ghazal, SA
影响因子：
5.9
作者：
Ligibel JA;Barry WT;Alfano C;Hershman DL;Irwin M;Neuhouser M;Thomson CA;Delahanty L;Frank E;Spears P;Paskett ED;Hopkins J;Bernstein V;Stearns V;White J;Hahn O;Hudis C;Winer EP;Wadden TA;Goodwin PJ
通讯作者：
Goodwin PJ