Top Line: Radiation’s long-term quality-of-life cost appears modest compared with the potential burden of multimodality treatment.
The Study: The SUPREMO trial informed us radiation to the chest wall (mostly without RNI) after mastectomy did not improve treatment outcomes for women with intermediate risk breast cancer. Its quality-of-life substudy reports radiotherapy was associated with slightly worse chest wall symptoms (e.g. discomfort, tightness, paresthisia), but these improved over time. Clinically meaningful worsening of chest wall symptoms at 5 years was reported by 13% of patients receiving radiotherapy versus 9% without. There were no significant differences in overall quality-of-life nor in the domains of physical function, fatigue, pain, arm/shoulder symptoms, body image, or anxiety/depression. As expected, chemo and more extensive axillary surgery showed signals of additional morbidity: Chemotherapy was associated with less improvement in chest wall and arm/shoulder symptoms over time, while patients who underwent completion axillary dissection had particularly worse chest wall symptoms with radiotherapy.
TBL: Chest wall radiotherapy does not result in a measurable decrement in global well-being; it even confers a low incremental risk of chest wall-specific symptomatology, particularly in the absence of axillary dissection. | Velikova, Lancet Oncol 2026
The Study: The SUPREMO trial informed us radiation to the chest wall (mostly without RNI) after mastectomy did not improve treatment outcomes for women with intermediate risk breast cancer. Its quality-of-life substudy reports radiotherapy was associated with slightly worse chest wall symptoms (e.g. discomfort, tightness, paresthisia), but these improved over time. Clinically meaningful worsening of chest wall symptoms at 5 years was reported by 13% of patients receiving radiotherapy versus 9% without. There were no significant differences in overall quality-of-life nor in the domains of physical function, fatigue, pain, arm/shoulder symptoms, body image, or anxiety/depression. As expected, chemo and more extensive axillary surgery showed signals of additional morbidity: Chemotherapy was associated with less improvement in chest wall and arm/shoulder symptoms over time, while patients who underwent completion axillary dissection had particularly worse chest wall symptoms with radiotherapy.
TBL: Chest wall radiotherapy does not result in a measurable decrement in global well-being; it even confers a low incremental risk of chest wall-specific symptomatology, particularly in the absence of axillary dissection. | Velikova, Lancet Oncol 2026