The Field of Radiation Therapy May Effect Health-Related Quality of Life in Patients With Operable Breast Cancer

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TO THE EDITOR: We read with great interest the article by Brandberg et al concerning the effects on healthrelated quality of life of two adjuvant anthracyclinecontaining treatments in high-risk breast cancer patients. They observed that higher levels of problems in arm symptoms were reported in the tailored fluorouracil, epirubicin, and cyclophosphamide group, compared with the high-dose chemotherapy with cyclophosphamide, thiotepa, and carboplatin group. In this study, locoregional radiotherapy was given daily in 2-Gy fractions five times per week to a total dose of at least 46 Gy. But details of radiotherapy that may affect the physical function and symptoms related to arm edema in both treatment groups were not mentioned. Whether or not the patients received lymphatic irradiation, particularly internal mammary irradiation, is important because internal mammary irradiation, and in some cases, tangential radiation to breast, may add to the cardiotoxicity caused by anthracycline, which may in turn affect physical function. On the other hand, axillary and supraclavicular radiation clearly increases the risk of lymphedema in the upper extremity, which is important for functional outcome.