Modifiable risk factors for acute skin toxicity in adjuvant breast radiotherapy: Dosimetric analysis and review of the literature

Keenan, L.; Lavan, Naomi; Dunne, Mary; McArdle, O.

doi:10.1016/j.meddos.2018.01.004

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Yang et al (21) compared wedge and FIF IMRT techniques in patients with small-sized breasts. The authors suggested that the conventional FIF method has favorable dose conformity and is an optimal method in patients with breast volume ≤350 cm 3 . Using the conventional FIF method, the authors reported a lung V20% of 14.42±2.61% and a heart V25% of 2.44±1.07% (21).…”

Section: Discussionmentioning

confidence: 99%

“…The highest grade of radiation dermatitis for each treated breast was prospectively recorded at each on treatment during the 5 or 6 weeks of treatment and at the follow-up visit at the week 6 or 7 for patients who received RT without or with boost, respectively, using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v3.0 grading criteria ( 12 ). The NCI CTCAE describes grade 0 as ‘no reaction’, grade 1 as ‘faint erythema or dry desquamation’, grade 2 as ‘moderate to brisk erythema, patchy moist desquamation mostly confined to skin folds and creases and moderate edema’, grade 3 as ‘moist desquamation other than skin folds or creases and bleeding induced by minor trauma or abrasion’ and grade 4 as ‘skin necrosis or ulceration of full thickness of the dermis, spontaneous bleeding from involved site’ ( 3 , 12 ). To ensure standard grading of skin toxicities for study purposes, all information regarding toxicity grade in individual patient were recorded and reviewed by a single experienced radiation oncologist.…”

Section: Methodsmentioning

confidence: 99%

“…WBRT reduces the risk of locoregional and distant first recurrence by 50%, and reduces breast cancer death by ~1/6 ( 1 , 2 ). However, most patients with breast cancer who undergo adjuvant radiotherapy (RT) are affected by skin toxicities ( 3 ). During RT treatment, these skin toxicities cause physical discomfort and emotional distress, and therefore negatively affect the patients' quality of life ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

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New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

et al. 2021

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The usefulness of the field-in-field with two reference points (FIF w/ 2RP) method, in which the dose reference points are set simultaneously at two positions in the irradiation field and the high-dose range is completely eliminated, was examined in the present study with the aim of decreasing acute skin toxicity in adjuvant breast radiotherapy (RT). A total of 573 patients with breast cancer who underwent postoperative whole breast RT were classified into 178 cases with wedge (W) method, 142 cases with field-in-field without 2 reference points (FIF w/o 2RP) method and 253 cases with FIF w/ 2RP method. Using the FIF w/ 2RP method, the high-dose range was the lowest among the three irradiation methods. The planning target volume (PTV) V105% and the breast PTV for evaluation (BPe) V105% decreased to 0.09 and 0.10%, respectively. The FIF w/ 2RP method vs. the FIF w/o 2RP method had a strong association (η) with PTV V105% (η= 0.79; P<0.001) and BPe V105% (η=0.76; P<0.001). The FIF w/ 2RP method had a significant impact on lowering the skin toxicity grade in weeks 3 and 4, and increasing the occurrence of skin toxicity grade 0. The FIF w/ 2RP method vs. the W method had a moderate association with skin toxicity grade at week 3 (η= 0.49; P<0.001). Using the FIF w/ 2RP method, the high-dose range V105% of the target decreased to 0%, and skin adverse events were decreased in conjunction. For patients with early-stage breast cancer, particularly patients with relatively small-sized breasts, the FIF w/ 2RP method may be an optimal irradiation method.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

et al. 2021

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“… 16 Keenan et al reported that a V 105 of greater than 30 cc is significantly associated with acute skin toxicity. 17 ARD is also affected by D max . 18 As our study employed the field-in-field technique and tangential breast IMRT, V 105 was small and the mean of D max was approximately 106% of the prescribed dose, which suggested that dose homogeneity was satisfactory and that dermatitis was mild.…”

Section: Discussionmentioning

confidence: 99%

Effect of Heparinoid Moisturizer on Quality of Life in Patients with Acute Radiation Skin Damage Following Hypofractionated Radiation Therapy After Breast-Conserving Surgery: A Randomized Controlled Study

Kawamori¹,

Itazawa²,

Fukushima³

et al. 2021

BCTT

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Background With few research reports on the effects of moisturizer use for dry skin associated with radiotherapy after breast-conserving surgery on patient quality of life (QOL), we conducted a randomized controlled trial to investigate this effect. Methods Patients with breast cancer were randomly assigned to receive either heparinoid moisturizer (Group M) or no treatment (Group C). Group M was instructed to apply heparinoid moisturizer during 3 weeks of hypofractionated whole-breast irradiation with or without boost until 4 weeks after completion of irradiation. Skin-related QOL was assessed using the Dermatology Life Quality Index (DLQI) for 7 weeks. The primary endpoint was total DLQI score at 4 weeks after the start date. Results In total, 35 patients in Group M and 37 patients in Group C were analyzed. The DLQI total score (2.06 ± 2.17: mean ± SD) at 4 weeks in Group M was slightly lower than in Group C (2.16 ± 2.13) but with no significant difference ( p = 0.894). The “Symptoms and feelings” subscore indicated significant worsening at 3 weeks and maintained until 7 weeks in Group C. There was no significant change for this subscore during radiotherapy in Group M, and it significantly increased after radiotherapy (4–5 weeks) and returned to baseline in 7 weeks. The period of subscore worsening was shorter in Group M than in Group C. Conclusion Concomitant and extended use of heparinoid moisturizer with radiation therapy may improve the QOL of breast cancer patients impaired by dry skin for patients with breast cancer.

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“…Ankur K et al investigated the dosimetric predictors of acute skin toxicity and found that the risk of skin toxicity was related to the percentage of clinical target volume (CTV) receiving 105% of the prescription dose (WB-CTV V105) (Patel et al 2019). It is thereby necessary to improve dose homogeneity, reduce V105 hotspots within target, for improving the WBI treatment outcomes (Keenan et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Dosimetric evaluation of different planning strategies for hypofractionated whole-breast irradiation technique

Tang,

Liu,

Yuan

et al. 2024

Phys. Med. Biol.

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Purpose: The dose hotspot areas in hypofractionated whole-breast irradiation greatly increase the risk of acute skin toxicity because of the anatomical peculiarities of the breast. In this study, we presented several novel planning strategies that integrate multiple sub-planning target volumes (sub-PTVs), field secondary placement, and RapidPlan models for right-sided hypofractionated whole-breast irradiation. Methods: A total of 35 cases of whole-breast irradiation with a dose of 42.5Gy for PTVs using tangential intensity-modulated radiotherapy(IMRT) were selected. Both PTVs were planned for simultaneous treatment using the original manual multiple sub-PTV plan (OMMP) and the original manual single-PTV plan (OMSP). The manual field secondary placement multiple sub-PTV plan (m-FSMP) with multiple objects on the original PTV and the manual field secondary placement single-objective plan (m-FSSP) were initially planned, which were distribution-based of V105(volume receiving 105% of the prescription dose). In addition, two RapidPlan-based plans were developed, including the RapidPlan-based multiple sub-PTVs plan (r-FSMP) and the RapidPlan-based single-PTV plan (r-FSSP). Dosimetric parameters of the plans were compared, and V105 was evaluated using multivariate analysis to determine how it was related to the volume of PTV and the interval of lateral beam angles (ILBA).Results: The lowest mean V105 (5.64±6.5%) of PTV was observed in m-FSMP compared to other manual plans. Upon validation, r-FSSP demonstrated superior dosimetric quality for OAR compared to the two other manual planning methods, except for V5(the volume of ipsilateral lung receiving 5 Gy) of the ipsilateral lung. While r-FSMP showed no significant difference (p=0.06) compared to r-FSSP, it achieved the lowest V105 value (4.3±4.5%), albeit with a slight increase in the dose to some OARs.Conclusions: m-FSMP and r-FSMP can substantially enhance the homogeneity index (HI) and reduce V105, thereby minimizing the risk of acute skin toxicities, even though there may be a slight dose compromise for certain OARs.

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Modifiable risk factors for acute skin toxicity in adjuvant breast radiotherapy: Dosimetric analysis and review of the literature

Cited by 12 publications

References 17 publications

New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

Effect of Heparinoid Moisturizer on Quality of Life in Patients with Acute Radiation Skin Damage Following Hypofractionated Radiation Therapy After Breast-Conserving Surgery: A Randomized Controlled Study

Dosimetric evaluation of different planning strategies for hypofractionated whole-breast irradiation technique

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