19: Trends in Patient-Reported Outcomes after Breast-Conserving Surgery and Partial Breast vs Whole Breast Irradiation

Saturday, March 23, 2024

9:10am - 9:20am ET

Location: C101

Abstract Presenter(s)

Julia M. Chandler, MD, MS (she/her/hers)

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Author(s)

Julia M. Chandler, MD, MS (she/her/hers)

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
Minji Kim, BS

Plastic and Reconstructive Surgery Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
VS

Varadan Sevilimedu, DrPH

Biostatistics Service, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center, United States
TL

Tiana V. Le, BS

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
JN

Jonas A. Nelson, MD, MPH

Plastic and Reconstructive Surgery Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
LB

Lior Z. Braunstein, MD

Department of Radiation Oncology
Memorial Sloan Kettering Cancer Center, United States
Monica Morrow, MD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Minna K. Lee, MD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Audree B. Tadros, MD, MPH

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, NY, United States

Disclosure(s):

Julia M. Chandler, MD, MS: No financial relationships to disclose

Introduction: Partial breast irradiation (PBI) has increased in popularity after multiple randomized trials demonstrated its oncologic safety in appropriately selected patients. PBI typically offers a more convenient treatment schedule with less normal tissue exposure compared to whole breast irradiation (WBI). Data on patient reported outcomes (PROs) after PBI vs WBI are mixed. We compared satisfaction with breasts (SABTR) and chest wall physical well-being (PWB-CHEST) using the BREAST-Q among patients undergoing PBI vs WBI.

Methods: BREAST-Q scores were analyzed preop and postop at 6 months, 1, 2, and 3 years among patients undergoing breast-conserving surgery (BCS) and radiation at a single institution. Patients with a prior history of breast radiation or metastatic disease were excluded. Patient, tumor, and treatment details were extracted from the medical record. Patients were stratified by type of radiation, and SABTR and PWB-CHEST scores were compared over time and with univariate and multivariate analyses (MVA).

Results: From 2017-2022, 6376 patients underwent BCS and responded to the BREAST-Q at ≥ 1 timepoint; 5213 (82%) underwent WBI and 1163 (18%) PBI. Response rates were 40%, 34%, 54%, 39%, and 24% at preop, 6 months, 1, 2, and 3 years postop, respectively. Patients undergoing WBI were younger and more often had axillary surgery compared to those undergoing PBI (SLNB 83% vs 78%, p < 0.001; ALND 6.9% vs 0.3%, p < 0.001). Preoperatively, patients undergoing PBI and WBI had similar SABTR; PWB-CHEST was slightly worse in the WBI group (Figure). At 6 months and 1 year after surgery, patients in the PBI group had higher SABTR and PWB-CHEST. By 3 years, there were no clinically significant differences in SABTR or PWB-CHEST between groups. On MVA, type of radiation was not associated with SABTR or PWB-CHEST at 6 months or 2 years postop. At 2 years, decreased SABTR was only associated with use of an aromatase inhibitor (ß = -4.3, p = 0.02), and decreased PWB-CHEST was associated with axillary surgery (ALND ß = -7.1, p = 0.029; SLNB ß = -5.9, p < 0.001), BMI > 25 (ß = 6.5, p = 0.016), and receipt of neoadjuvant chemotherapy (ß = -5.0, p = 0.014).

Conclusions: Patients undergoing BCS with PBI or WBI had similar breast satisfaction and chest wall well-being at early and late postoperative timepoints. Other patient- and treatment-related variables such as BMI, use of an aromatase inhibitor, and axillary surgery were significantly associated with long-term breast satisfaction and chest wall well-being. These findings support the use of PBI as an alternative to WBI in eligible patients.

Learning Objectives:

Describe the BREAST-Q patient-reported outcome measure
Recognize the trends in breast satisfaction and chest wall physical well-being over time after breast-conserving therapy.
Identify factors associated with worse breast satisfaction and chest wall physical well-being after breast-conserving therapy.