Dermatologic toxicities associated with radiation therapy in women with breast cancer

Abstract

Breast-conserving surgery with adjuvant radiation therapy has become the standard of care for women with early stage breast cancer, and as a result, a large number of patients are affected by the cutaneous sequelae of radiation therapy. These dermatologic toxicities may present during treatment or years later and can significantly impact patients’ quality of life. In this review, we discuss the clinical presentation, prevention, and management of radiation-induced cutaneous toxicities in women with breast cancer, including radiation dermatitis, radiation recall, radiation-induced morphea, radiation-induced fibrosis, and cutaneous malignancies in irradiated skin.

Radiation-irritated skin and hyperpigmentation may impact the quality of life of breast cancer patients after whole breast radiotherapy

“…“Radiation-irritated skin” is a brand-new concept of the sequelae of radiation therapy that no one reported in the past. According to previous studies, [ 6 , 12 , 14 , 15 ] we concluded that the possible pathological mechanism of “Radiation-irritated skin” may consist of changes such as thickening of epidermis, hyperkeratosis, and atrophy of sweat gland and sebaceous gland.(Fig. 3 ) In this study, 46.3% of breast cancer patients after whole breast radiotherapy may develop “radiation-irritated skin”.…”

“…Acute radiation dermatitis, defined as a skin reaction that appears within 90 days of initiation of radiation exposure. There skin reactions usually start to occur within days to weeks after the initiation of radiation therapy [ 14 ]. The clinical manifestations are acute redness, edema, dyspigmentation, hair loss, and dry desquamation.…”

“…Chronic radiation dermatitis is defined as a skin reaction that appears more than 90 days after the end of radiation treatment [ 19 ]. The manifestations include epidermal thickness, dermis atrophy, keratinization, skin fibrosis, vascular injury, and telangiectasias [ 6 , 12 , 14 ]. Most of these chronic radiation dermatitis reactions are irreversible.…”

“…Chronic radiation dermatitis, which appears 90 days after the end of the course of treatment, may be permanent and irreversible. Common clinical manifestations include xerosis, hyperkeratosis, dyspigmentation, telangiectasia, and absent sweating [12][13][14]. Clinical observations and animal models indicate that the skin dryness and absent sweating is due to the pathophysiological changes of the sweat glands and sebaceous glands caused by radiation.…”

Targeted Next-Generation Sequencing for the Identification of Genetic Predictors of Radiation-Induced Late Skin Toxicity in Breast Cancer Patients: A Preliminary Study

“…However, a significant proportion of long-term survivors experience late RT-related complications that may develop from six months to several years after radiation exposure [3]. Late adverse reactions to radiotherapy are generally irreversible and include a wide spectrum of normal tissue reactions, with subcutaneous fibrosis and telangiectasia being the most common late skin complications of radiotherapy for breast cancer [4]. Ionizing radiation generates reactive oxygen species that lead to localized inflammation, which ultimately evolves into a fibrotic process characterized by increased collagen deposition, poor vascularity, and scarring [5].…”