Nacho supremo.

Top Line: Quality of life should play a role in soft call indications for post-mastectomy radiation. 
The Study: The SUPREMO trial randomized (or rather randomised) women with “intermediate risk” breast cancer to +/- post-mastectomy radiation. Intermediate risk included T1-2N1, T3N0, and T2N0 if grade 3 or with LVSI—think MA.20/Poortmans inclusion. The primary outcome is overall survival, but reported here (long before that) is quality of life (QoL) data. An important aspect that is going to be all the talk at ASTRO 2023—probably in San Antonio—is that nearly 70% of patients were treated with 40 Gy in 15 fractions to the chest wall and/or regional nodes. Most patients reported reduced QoL at enrollment (i.e., after chemo), which generally improved over time regardless of treatment arm. The only real symptom scale that was impacted by radiation was chest wall symptoms, though chemo independently made it worse. In fact chemo, not radiation, was associated with worse arm and shoulder symptoms. One other thing: As we’ve learned from prostate cancer, disease recurrence really reduces QoL. Maybe we’re even seeing some early effects on QoL from recurrence differences between arms... #trendstatement
Bottom Line: Post-mastectomy (mostly hypofractionated) chest wall radiation does not reduce overall QoL and has less of an impact than chemo in women with intermediate risk breast cancer.  | Velikova, Lancet Oncol 2018


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