Patient-Reported Quality of Life After Hypofractionated Versus Conventional Adjuvant Radiotherapy for Stage IIB–IIIC Breast Cancer: A Prospective 12-Month Cohort Study from Uzbekistan

Abstract

Background: Moderately hypofractionated radiotherapy (HFRT) is standard for early breast cancer, but patient-reported evidence in higher-stage, multimodally treated patients and in capacity-constrained settings remains limited. We compared health-related quality of life (HRQoL) after HFRT and conventional fractionation in stage IIB–IIIC disease.
Methods: In this prospective, non-randomized cohort study at a national cancer centre in Uzbekistan (2020–2022), 109 women with stage IIB–IIIC breast cancer who had received neoadjuvant chemotherapy and surgery underwent 3D-conformal radiotherapy to the chest wall or breast and regional nodes with HFRT (42.56 Gy in 16 fractions; n=54) or conventionally fractionated radiotherapy (CFRT; 50 Gy in 25 fractions; n=55). The EORTC QLQ-C30 and QLQ-BR23 were completed before radiotherapy, at completion, and at 6 and 12 months. Between-group mean differences with 95% confidence intervals (CIs) were interpreted against a 10-point minimal important difference (MID).
Results: Baseline HRQoL was similar between groups. At radiotherapy completion, emotional functioning was maintained with HFRT but declined with CFRT (84.5 vs 72.1; difference 12.4 points, 95% CI 0.7–24.1; p=0.038), a difference exceeding the MID that resolved by 6 months. Physical functioning, fatigue, nausea/vomiting, chest-wall discomfort, and arm symptoms did not differ at any time point. At 12 months, the 95% CIs excluded a clinically meaningful (≥10-point) disadvantage of HFRT for physical and emotional functioning and for all evaluated symptom scales; global health status improved in both groups (76.3 vs 73.5; difference 2.8, 95% CI −10.9 to 16.5). Grade III acute skin reactions occurred in three patients in each group.
Conclusions: In stage IIB–IIIC breast cancer, HFRT shortened treatment by approximately 2 weeks (nine fewer fractions) without a detectable clinically meaningful HRQoL detriment at 12 months and was associated with less acute emotional burden at treatment completion. These findings extend patient-reported support for moderate hypofractionation to higher-stage, multimodally treated patients and to capacity-constrained radiotherapy services; the emotional-functioning signal is exploratory and warrants confirmation.
– Prospective patient-reported comparison of hypofractionated and conventional adjuvant radiotherapy in stage IIB–IIIC breast cancer from Central Asia.
– Women treated after multimodal therapy, including both mastectomy and breast-conserving surgery.
– 95% CIs excluded a clinically meaningful HRQoL disadvantage of hypofractionation at 12 months for all functional and symptom scales evaluated.
– Conventional fractionation was associated with a transient, clinically meaningful decline in emotional functioning at treatment completion.
– Nine fewer fractions per patient: relevant for radiotherapy capacity in resource-constrained settings.