Lebensqualität nach intraoperativer Radiotherapie (IORT) als Boost beim Mammakarzinom

Zusammenfassung

Fragestellung: Die intraoperative Radiotherapie (IORT) als Boost während einer brusterhaltenden Therapie (BET) kommt weltweit immer häufiger zum Einsatz. In dieser Analyse wurden die Lebensqualität und Spätfolgen nach IORT-Boost und perkutaner Bestrahlung (EBRT) retrospektiv bei einem Querschnittskollektiv untersucht. Material und Methodik: Zwischen 2/2002 und 12/2006 erhielten 142 Patientinnen (medianes Alter 63 Jahre) einen IORT-Boost (20 Gy; INTRABEAM-System). Nach abgeschlossener Wundheilung und/oder Chemotherapie wurde mit der EBRT begonnen (46–50 Gy). Die Lebensqualitätserhebung erfolgte mittels der standardisierten und validierten Fragebögen QLQ‐C‐30 und QLQ-BR-23 im Median 34 Monate nach Ende der EBRT bei 103 Patientinnen. Es erfolgte alle 6–12 Monate eine klinische Nachsorge, wobei Spättoxizitäten anhand des LENT SOMA Scores erfasst wurden. Ergebnisse: Bei einer medianen Nachbeobachtungszeit von 32 Monaten ergaben die Spättoxizität und die Lebensqualität gute/sehr gute Ergebnisse nach IORT-Boost. Die allgemeine Lebensqualität fiel gut aus und unterschied sich nicht klinisch relevant (> 10 Punkte Unterschied) von einer altersadjustierten deutschen Normstichprobe bei statistisch signifikant niedrigerem Mittelwert (58,66 vs. 64,77 Punkte; p = 0,016). Patientinnen mit höhergradigen Toxizitäten hatten signifikant mehr Emesis/Nausea (p = 0,018), Obstipation (p = 0,002), Brustsymptome (p = 0,008), Armsymptome (p = 0,013) und eine gering schlechtere allgemeine Lebensqualität (60,58 vs. 56,74 Punkte). Den stärksten Einfluss zeigten Schmerzen > °II. Zufriedene Patientinnen (89 %) hatten signifikant weniger Brust- und Armsymptome (p < 0,001) und wiesen weniger höhergradige Spättoxizitäten auf (p = 0,004). Schlussfolgerung: Patientinnen mit IORT-Boost zeigen eine gute Lebensqualität nach einer medianen Nachsorgezeit von fast 3 Jahren. Höhergradige Toxizitäten übten in nur wenigen Bereichen einen negativen Einfluss auf die Lebensqualität aus.

Abstract

Purpose: Intraoperative radiotherapy (IORT) is increasingly used as a boost during breast conserving surgery. In a retrospective cross-sectional analysis, we assessed the Quality of Life (QoL) and late toxicity in women treated with an IORT boost followed by whole breast irradiation (WBRT). Material and Methods: Between 02/2002 and 12/2006, 142 patients (median age: 63 years) were treated with an IORT boost (20 Gy; INTRABEAM System) and WBRT (46–50 Gy) after completed wound healing or chemotherapy. After a median interval of 34 months after WBRT, QoL data were assessed in 103 patients using two reliable, validated questionnaires: the QLQ‐C30 and QLQ-BR23. We also carried out clinical examinations every 6–12 months and documented late effects according to the LENT SOMA scale. Results: At a median follow-up of 32 months most toxicity and QoL scores were good/excellent and QoL showed no clinically relevant difference of > 10 points compared to an age-adjusted population. However, our patients had significantly lower ratings for global health/QoL (58.66 vs. 64.77; p = 0.016). Patients with higher grade toxicities reported significantly more emesis/nausea (p = 0.018), constipation (p = 0.002), breast (p = 0.008) and arm symptoms (p = 0.013) and showed a worse QoL (56.74 vs. 60.58 points). Pain > °II had the greatest impact. Satisfied patients (89 %) reported fewer breast and arm symptoms (p < 0.001) and fewer higher grade toxicities (p = 0.004). Conclusion: Patients with an IORT boost had a good QoL at a median follow-up of nearly three years. Higher grade toxicity had a small impact on QoL.

Schlüsselwörter

intraoperative Radiotherapie - Brustkrebs - Boost - Toxizität - Lebensqualität

Key words

intraoperative radiotherapy - breast cancer - boost - toxicity - quality of life

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