Radiotherapy given as lower overall doses results in better quality of life for cancer patients

Patients with breast cancer do not experience increased adverse symptoms when given radiotherapy in fewer, larger daily doses, according to a study published in The Lancet Oncology (2010 Feb 5. [Epub ahead of print]).

In a study led by Penelope Hopwood, researchers studied the effects of different radiotherapy regimens up to 5 years after treatment on adverse skin changes and body image. Women who were given radiotherapy after primary surgery for early-stage breast cancer completed quality-of-life questionnaires and self-assessments of body image and radiotherapy effects on healthy tissues at regular intervals for 5 years after treatment.

Researchers revealed that over a 5-year period, the most frequently reported adverse effects were breast hardness (41%) and change in breast appearance (39%). Additionally, up to 33% of patients experienced arm and shoulder pain, while the 5-year rate of moderate or marked shoulder stiffness was about 20%. However, many arm and shoulder symptoms were present at the start of the study and were associated with previous surgery.

Further reports revealed that an adverse change in skin appearance after radiotherapy was the only symptom to differ significantly between the radiotherapy schedules, but the overall pattern for all adverse effects was similar, with lower or similar rates for the schedules with a higher daily dose compared with the international standard treatment.

When the effects on body image were measured, the team found that 40% of women reported moderate or striking concerns for at least one body-image item up to 5 years following treatment. Among the most common concerns were feeling physically less attractive (23%) and dissatisfaction with body (23%).

“Considerable morbidity still arises due to effects on normal [healthy] tissues of treatment for early breast cancer, and patients' self-assessments are important to ascertain the extent and duration of these effects,” the authors pointed out. “These ratings by patients…strengthen evidence in favour of hypofractionated regimens, [with the potential for] reduced adverse normal breast tissue effects reported, [and] have important implications for radiotherapy practice.”

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