Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS)

Abstract

Purpose/ObjectivesStandard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy.Materials/MethodsBetween 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24–77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19.ResultsAfter 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema.In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005).Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate analysis, factors associated with higher grade skin toxicity were larger breast target volume (p=0,003), smoking (p=0,034) and absence of allergies (p=0,002).ConclusionPatients treated in this study showed less objectively documented skin toxicity after 50 Gy 3D-CRT compared to similar patient cohorts. Factors associated with higher grade skin toxicity were smoking during 3D-CRT, absence of allergies and larger breast volumes.

Using a thermoluminescent dosimeter to evaluate the location reliability of the highest–skin dose area detected by treatment planning in radiotherapy for breast cancer

“…Previous reports have suggested that patients with a larger breast size may have a more severe skin reaction than those with a smaller breast size. 10,23 The data revealed that the consistency between the 2 methods in the axillary and breast areas tended to be limited to patients with a large breast size. This finding implies that the TPS may be a feasible, alternative method for predicting skin reactions in this type of vulnerable patient.…”

Risk Factors for the Development of Acute Radiation Dermatitis in Breast Cancer Patients

“…Increased risk of acute dermatitis was found with standard fractionation schedules, 3D-CRT technique compared to IMRT, largest breast size, high BMI, and smoking. 10,[15][16][17] Across these studies there was significant disagreement on the most significant factors for the development of acute breast radiation dermatitis, likely due to the smaller study number of these retrospective reviews. In our study, BMI, total radiation dose, and radiation fractionation schedule appear to be the most important factors for development of breast radiation dermatitis.…”

Dosimetric comparison of three intensity‐modulated radiation therapies for left breast cancer after breast‐conserving surgery

“…Radiation pneumonitis and pulmonary fibrosis are important complications of radiation‐induced pneumonitis for breast cancer 21, 22, 23. Occurrence rate of complications is significantly correlated with irradiation volume and dose in lung tissues.…”