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dc.contributor.authorBhattacharya, Indrani S
dc.contributor.authorHaviland, Joanne S
dc.contributor.authorKirby, Anna M
dc.contributor.authorKirwan, Cliona C
dc.contributor.authorHopwood, Penelope
dc.contributor.authorYarnold, John R
dc.contributor.authorBliss, Judith M
dc.contributor.authorColes, Charlotte
dc.contributor.authorIMPORT Trialists
dc.date.accessioned2019-01-16T00:31:09Z
dc.date.available2019-01-16T00:31:09Z
dc.date.issued2019-02-01
dc.identifier.issn0732-183X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/288038
dc.description.abstractPURPOSE: IMPORT LOW demonstrated noninferiority of partial-breast and reduced-dose radiotherapy versus whole-breast radiotherapy for local relapse and similar or reduced toxicity at 5 years. Comprehensive patient-reported outcome measures collected at serial time points are now reported. PATIENTS AND METHODS: IMPORT LOW recruited women with low-risk breast cancer after breast-conserving surgery. Patients were randomly assigned to 40 Gy whole-breast radiotherapy (control), 36 Gy whole-breast and 40 Gy partial-breast radiotherapy (reduced-dose), or 40 Gy partial-breast radiotherapy only (partial-breast) in 15 fractions. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 and Breast Cancer-Specific Module, Body Image Scale, protocol-specific items, and the Hospital Anxiety and Depression Scale were administered at baseline, 6 months, and 1, 2, and 5 years. Patterns of moderate/marked adverse effects (AEs) were assessed using longitudinal regression models, and baseline predictors were investigated. RESULTS: A total of 41 of 71 centers participated in the patient-reported outcome measures substudy; 1,265 (95%) of 1,333 patients consented, and 557 (58%) of 962 reported no moderate/marked AEs at 5 years. Breast appearance change was most prevalent and persisted over time (approximately 20% at each time point). Prevalence of breast hardness, pain, oversensitivity, edema, and skin changes reduced over time ( P < .001 for each), whereas breast shrinkage increased ( P < .001). Analysis by treatment group showed average number of AEs per person was lower in partial-breast (incidence rate ratio, 0.77; 95% CI, 0.71 to 0.84; P < .001) and reduced-dose (incidence rate ratio, 0.83; 95% CI, 0.76 to 0.90; P < .001) versus whole-breast group and decreased over time in all groups. Younger age, larger breast size/surgical deficit, lymph node positivity, and higher levels of anxiety/depression were baseline predictors of subsequent AE reporting. CONCLUSION: Most AEs reduced over time, with fewer AEs in the partial-breast and reduced-dose groups. Baseline predictors for AE reporting were identified. These findings will facilitate informed discussion and shared decision making for future patients receiving moderately hypofractionated breast radiotherapy.
dc.description.sponsorshipWe acknowledge support from Cancer Research UK (grant number C1491/A6035), the National Institute for Health Research (NIHR) Cancer Research Network (CRN), National Health Service Research Scotland, Health and Care Research Wales and the National Institute of Health Research Royal Marsden/ Institute of Cancer Research Biomedical Research Centre. In addition Dr Charlotte Coles is supported by the Cambridge National Institute of Health Research Biomedical Research Centre. Dr Indrani Bhattacharya is supported by a Cancer Research UK clinical trial fellowship (C1491/A8895).
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherAmerican Society of Clinical Oncology (ASCO)
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectIMPORT Trialists
dc.subjectHumans
dc.subjectBreast Neoplasms
dc.subjectRadiation Injuries
dc.subjectTreatment Outcome
dc.subjectRadiotherapy, Adjuvant
dc.subjectIncidence
dc.subjectPrevalence
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectLongitudinal Studies
dc.subjectDepression
dc.subjectAnxiety
dc.subjectBody Image
dc.subjectTime Factors
dc.subjectQuality of Life
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectPatient Reported Outcome Measures
dc.subjectRadiation Dose Hypofractionation
dc.titlePatient-Reported Outcomes Over 5 Years After Whole- or Partial-Breast Radiotherapy: Longitudinal Analysis of the IMPORT LOW (CRUK/06/003) Phase III Randomized Controlled Trial.
dc.typeArticle
prism.endingPage317
prism.issueIdentifier4
prism.publicationDate2019
prism.publicationNameJ Clin Oncol
prism.startingPage305
prism.volume37
dc.identifier.doi10.17863/CAM.35357
dcterms.dateAccepted2018-10-16
rioxxterms.versionofrecord10.1200/JCO.18.00982
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-02
dc.contributor.orcidColes, Charlotte [0000-0003-4473-8552]
dc.identifier.eissn1527-7755
rioxxterms.typeJournal Article/Review


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International