No difference in dose distribution in organs at risk in postmastectomy radiotherapy with or without breast implant reconstruction

The aim of this study was to quantify the variation in doses to organs at risk (ipsilateral lung and heart) and the clinical target volume (CTV) in the presence of breast implants. In this retrospective cohort study, patients were identified through the National Breast Cancer Register. Consecutive breast cancer patients undergoing mastectomy between 2009 and 2011 and completing a full course of postmastectomy radiotherapy (PMRT) were eligible. All included patients (n = 818) were identified in the ARIA© oncology information system and further stratified for immediate breast reconstruction (IBR+, n = 162) and no immediate breast reconstruction (IBR-, n = 656). Dose statistics for ipsilateral lung, heart and CTV were retrieved from the system. Radiation plans for patients with chest wall (CW) only (n = 242) and CW plus lymph nodes (n = 576) irradiation were studied separately.The outcome variables were dichotomized as follows: lung, V(20Gy) ≤ 30% vs. V(20Gy) > 30%; heart, D(mean) ≤ 5 Gy vs. D(mean) > 5 Gy; CTV, V95% ≥ median vs. V95% < median.In the univariate and multivariate regression models no correlation between potential confounders (i.e. breast reconstruction, side of PMRT, CW index) and the outcome variables was found. Multivariate analysis of CW plus lymph nodes radiation plans, for example, showed no association of breast reconstruction with dosimetric outcomes in neither lung nor heart- lung V(20Gy) (odds ratio [OR]: 0.6, 95%CI, 0.4 to 1.0, p = 0.07) or heart D(mean) (OR: 1.2, 95%CI, 0.5 to 3.1, p = 0.72), respectively.CTV was statistically significantly larger in the IBR+ group (i.e. included breast implant), but no correlation between the implant type and dosimetric characteristics of the organs at risk was revealed.In the current study, the presence of breast implants during postmastectomy radiotherapy was not associated with increased doses to ipsilateral lung and heart, but CTV definition and its dosimetric characteristics urge further evaluation

Contralateral prophylactic mastectomy in breast cancer patients with a family history: a prospective 2-years follow-up study of health related quality of life, sexuality and body image

INTRODUCTION: Contralateral prophylactic mastectomy (CPM) is the most effective option to prevent the occurrence of a second breast cancer in hereditary breast cancer patients. This study aimed to prospectively evaluate health-related quality of life (HRQoL), anxiety and depression, sexuality and body image in breast cancer patients with a family history undergoing CPM with immediate breast reconstruction. PATIENTS AND METHODS: In total, 60 of 69 eligible patients agreed to participate in the study. Four validated questionnaires were used: the SF-36, the Hospital Anxiety and Depression Scale (HAD), the Body Image Scale (BIS), and the Sexual Activity Questionnaire (SAQ). Forty-five patients (75%) responded before CPM, 49 (82%) at 6 months, and 45 (75%) at 2 years after CPM. RESULTS: Overall, the patients showed a satisfactory HRQoL 2 years after CPM, similar to women in the general population. There were no differences in HRQoL, anxiety, depression or sexuality before and after CPM. However, more than half of the women reported at least one body image problem 2 years postoperatively. CONCLUSION: No adverse effects on HRQoL, anxiety, depression or sexuality were observed. However, some aspects of body image were negatively affected after CPM. These findings could be used in preoperative counselling of breast cancer patients opting for CPM

Long-term Donor Site-related Quality of Life after Deep Inferior Epigastric Perforator Flap Breast Reconstruction

BACKGROUND: Current knowledge about patients' perceptions of the donor site following abdominal-based breast reconstruction and its effect on health-related quality of life (HRQoL) several years after breast reconstruction is limited. This study aimed to assess the long-term effects of deep inferior epigastric perforator (DIEP) flap breast reconstruction on HRQoL, specifically focusing on the abdomen and donor site aspects. METHODS: This retrospective cohort study compared 66 women who underwent DIEP breast reconstruction between 2000 and 2007 with a matched control cohort of 114 women who underwent therapeutic mastectomies without reconstruction in the year 2005. The DIEP cohort of patients completed the BREAST-Q Reconstruction module during an outpatient visit in 2015-2016. The control cohort completed the same questionnaire online in 2016. RESULTS: The follow-up time was at least 8 years (mean 11.4 ± 1.6 years) postreconstruction for the DIEP cohort and 10 years postmastectomy (mean 11.0 ± 0.3 years) for the control cohort. In the DIEP cohort, 93% reported no donor site pain, 89% had no difficulty sitting up, and 91% had no activity limitations 2 weeks before completing the survey. Patients undergoing DIEP were more satisfied with their abdominal appearance than the control group (adjusted OR, 5.7; 95% confidence interval 1.8-17.6). CONCLUSIONS: A decade postoperatively, DIEP breast reconstruction yields high abdominal donor site satisfaction, with comparable abdominal physical well-being to nonreconstructed women

Phase III development of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire module for women undergoing breast reconstruction

BACKGROUND: Comprehensive outcome assessments after breast reconstruction (BRR) require surgery-specific patient-reported outcome measures. The aims of this study were to assess the relevance, acceptability and redundancy of questions/items (phase III pretesting) of a new BRR questionnaire evaluating patients' health-related quality of life before and after BRR. Phase III occurred in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) following earlier development phases that identified 31 items. METHODS: The EORTC BRR subgroup applied decision-making rules to each question according to eight EORTC criteria. A total of 197 patients (from the UK, Austria, Belgium, Italy and Sweden) were recruited. Forty-seven patients completed pre- and post-BRR questionnaires prospectively, and 150 reported post-BRR questionnaires only retrospectively. Qualitative debriefing interviews were undertaken in 189 patients. Preliminary psychometric analyses were performed. RESULTS: Thirty-one items fulfilled 'relevance', with none producing 'difficulties'. Ten items were not a priority for 10 per cent of respondents. Of these, two questions concerning muscle twitching in the affected breast and problem with donor-site swelling were deleted. Three redundant items were deleted: weakness in arm, which correlated significantly to the Quality of Life Questionnaire (QLQ) BR23 breast questionnaire, and shape and colour of the affected nipple. Descriptive statistics reduced the module to 26 items conceptualized into three provisional scales (disease treatment/surgery-related symptoms, sexuality and cosmetic outcome) within the newly completed questionnaire, EORTC QLQ-BRR26. CONCLUSION: The QLQ-BRR26 is available for psychometric validation in a large-field international sample. The intended use for QLQ-BRR26 is alongside EORTC QLQ-C30 and QLQ-BR23, in women treated by mastectomy for breast cancer and undergoing all types of BRR

Abstract P2-19-08: Phase III development of the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) module for women undergoing breast reconstruction: The EORTC QLQ-BRR26

Abstract Introduction: Comprehensive outcome assessments after breast reconstruction (BRR) require surgery- specific Patient Reported Outcomes Measures (PROMS). Completion of early Phases I-II development resulted in a 31-item questionnaire comprising 5 hypothesised scales and (numbers of items) : Treatment /surgery related symptoms (4), body image (3), sexuality (4), cosmetic outcomes (breast, n = 7, donor site, n = 5, nipple, n = 6) and overall satisfaction (2). Current evidence shows no BRR-specific PROM, with the further validation of the BREAST-Q, currently the only PROM. The aim of this study was Phase III pre-testing of a BRR questionnaire assessing patients’ health related quality of life (HRQL) before and after BRR, in collaboration with the European Organisation for Research and Treatment of Cancer (EORTC). Pre-testing assessed the relevance, acceptability and redundancy of questions in all types of BRRs. This PROM is intended for use alongside the EORTC QLQ-C30, and QLQ-BR23 in women treated for breast cancer before and after mastectomy and all BRR types. Methods: The EORTC BRR HRQL subgroup applied decision-making rules to each question according to eight EORTC criteria comprising 1. priority, 2. relevance and 3. difficulty /consistency across five European languages and cultures. Descriptive statistics used HRQL score criteria: 4. mean &amp;gt;1.5, 5. range &amp;gt;2, 6. floor and ceiling effects &amp;gt;10%, 7. prevalence ratios &amp;gt;30% and 8. compliance &amp;gt;95%. 197 patients (UK, Austria, Belgium, Italy, Sweden) were recruited: 47 prospectively completing pre- and post-BRR questionnaires, and 150 retrospectively reporting only post-BRR questionnaires. 189 patients underwent qualitative debriefing interviews. Preliminary psychometric analyses performed multi-trait scaling using EORTC QLQ-C30 and QLQ- BR23 that were used in final decisions on items and scales. Results: 31 questions /items fulfilled ‘relevance’, with none producing ‘difficulties’. Ten items were not a ‘priority’ in 10% of respondents. Of these, two questions comprising ‘muscle twitching in affected breast’ and ‘problem with donor site swelling’ were deleted, fulfilling less than 5 out of 8 criteria. Deletions of three redundant items comprised ‘weak arm’, which correlated significantly to QLQ-BR23; and ‘shape’ and ‘colour’ of affected nipple with similarities to ‘overall nipple appearance’. Descriptive statistics and clinical judgment reduced the module to 26 items conceptualized into three scales (and items): Disease Treatment /Surgery related symptoms (2), Sexuality (5), and Cosmetic outcomes (breast, n = 10, donor site, n = 4, nipple, n = 4) within the EORTC QLQ-BRR26. The body image and overall satisfaction scales were dropped, with their respective items incorporated into other scales. Discussion: The QLQ-BRR26 has completed phase III development and is available for psychometric validation in a large field international sample that aims to recruit 450 patients across 17 European centres. Psychometric testing will be finalised in Phase IV including the evaluation of the questionnaires’ responsiveness to the effects of BRR subgroups with comparisons to the BREAST-Q. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-08.</jats:p