An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy

Abstract

BackgroundTo determine the usefulness of ultrasonography in the assessment of post radiotherapy skin changes in postmastectomy breast cancer patients.MethodsPatients treated for postmastectomy radiotherapy in National University Hospital (NUH) and Tan Tock Seng Hospital (TTSH), Singapore between January 2004- December 2005 was recruited retrospectively. Ultrasound scan was performed on these Asian patients who had been treated to a total dose of 46-50 Gy with 1 cm bolus placed on the skin. The ultrasound scans were performed blinded to the RTOG scores, and the skin thickness of the individually marked points on the irradiated chest wall was compared to the corresponding points on the non-irradiated breast.ResultsThe mean total skin thickness inclusive of the epidermis and the dermis of the right irradiated chest wall was 0.1712 mm (± 0.03392 mm) compared with the contra-lateral non-irradiated breast which was 0.1845 mm (± 0.04089 mm; p = 0.007). The left irradiated chest wall had a mean skin thickness of 0.1764 mm (± 0.03184 mm) compared with the right non-irradiated breast which was 0.1835 mm (± 0.02584 mm; p = 0.025). These independent t-tests produced a significant difference of reduced skin thickness on the right irradiated chest wall, p = 0.007 (p < 0.05) and left irradiated chest wall p = 0.025 (p < 0.025) in comparison to the non-irradiated skin thickness investigating chronic skin reactions. Patients with grade 2 acute skin toxicity presented with thinner skin as compared to patients with grade 1 (p = 0.006).ConclusionsThis study has shown that there is a statistically significant difference between the skin thicknesses of the irradiated chest wall and the contra-lateral non-irradiated breast and a predisposition to chronic reactions was found in patients with acute RTOG scoring of grade1 and grade 2.

High‐frequency ultrasound quantification of acute radiation dermatitis: pilot study of patients undergoing radiotherapy for breast cancer

“…It also negatively affects the quality of life of patients . Reducing the frequency and severity of this event can be beneficial to patients and result in immediate improvement in comfort but also decrease the risk of certain rare and delayed events such as chronic radiation dermatitis, carcinoma, and sarcomas, although the link between acute and late radiation dermatitis is not fully established …”

An ultrasonographic monitoring of skin condition in patients receiving radiotherapy for head and neck cancers

“…For example, Warszawski et al as well as Huang et all. observed the thickening, while Wong et al reported thinning within irradiated skin . According to us, those discrepancies could be caused by natural evolution of fibrotic process in the skin.…”

“…So far, just a few studies have reported on usefulness of USG in the assessment of radiation dermatitis . Except one, most of those researches included exclusively patients with breast cancer . Their results indicated that thickening of the irradiated areas of the skin correlates with more severe skin reactions .…”

Hyperspectral Imaging and Classification for Grading Skin Erythema

“…The VA scale used for this study was developed specifically to grade subtle erythematic changes in the subject's skin within the ROI. More widely used clinical assessment tools for skin toxicities including Common Terminology Criteria for Adverse Events (CTCAE), and Radiation Therapy Oncology Group (RTOG) were too coarse and did not suit the needs of this study [13,19].…”