The effect of postmastectomy radiotherapy on patient-reported outcomes
Menée à partir de questionnaires auprès de 989 patientes atteintes d'un cancer du sein à risque intermédiaire de récidive et incluses dans un essai multicentrique évaluant une mastectomie en combinaison ou non avec une chirurgie axillaire et une radiothérapie ciblant la paroi thoracique, cette étude évalue l'effet de la radiothérapie sur la qualité de vie des patientes (fatigue, fonctions physiques, symptômes au niveau de la paroi thoracique, symptômes d'anxiété et de dépression, ...)
Postmastectomy radiotherapy is included in the management of breast cancer in an effort to eradicate potential microscopic residual disease within the chest wall or regional lymph nodes. In the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) 2014 meta-analysis, which included 8135 women in 22 trials, radiotherapy after mastectomy and axillary node dissection in women with one to three positive lymph nodes was associated with an 11·5% absolute reduction in the risk of any first recurrence and a 7·9% improvement in 20-year risk of breast cancer mortality. 1 However, controversy persists over the role of postmastectomy radiotherapy in women with intermediate-risk (one to three positive lymph nodes) breast cancer. Participants in the EBCTCG trials were accrued from 1964 to 1986 and the reported outcomes might not reflect those of women diagnosed with node-positive breast cancer today. Since then, the discovery of molecular assays has improved the prognostic stratification of early-stage breast cancer, enabling the identification of women with node-positive disease who have a low risk of recurrence. 2 Advances in systemic therapy reduce the risks of locoregional recurrence as well as distant metastases. 3 Consequently, the prognosis of women with one to three positive nodes is increasingly variable, and includes a substantial proportion of women with low risk of recurrence, for whom the benefits of postmastectomy radiotherapy remain unclear. If the potential absolute benefit of postmastectomy radiotherapy is small, knowledge about the detrimental effects is prudent to enable informed decision making.