Breast Cancer Acute Radiotherapy Morbidity Evaluated by Different Scoring Systems

Abstract

Reporting of the outcome of radiotherapy is not satisfactory without a description of the treatment-related side effects. The purposes of this paper were: (1) to evaluate the frequency and the severity of collateral skin reactions in a group of breast cancer patients; (2) to report the acute reactions using some current scoring systems and to compare the application of them, and (3) to investigate the variation between intra- and interobservers using these different scales. We studied 108 breast cancer patients who, after surgical treatment, received adjuvant radiotherapy. Clinical skin evaluation was always performed by the same radiotherapist the last day of treatment, and the collateral radiation effects were photographed at that moment to facilitate later evaluations by another two expert doctors. Normal tissue damage was scored according to the Radiation Therapy Oncology Group/The European Organisation for Research, and Treatment of Cancer/ (RTOG/EORTC), the Danish, the European, and the Biomed2 side-effect scales. The most frequent acute complications found were erythema (91.7%), dry desquamation (29.6%) and moist desquamation (35.2%). The reactions were classified as severe in 13.9, 23, 18.5 and 13% of the patients with each of the different systems used, respectively. The concordance between the scoring of radiation-induced side effects on the skin assessed by direct observation of the patients or by examination of the photographic document was sufficient. This is a warrant of accuracy in the evaluation of acute normal tissue lesions. Our results allow us to state the advantage of the RTOG system over the others in terms of evaluating the acute effects produced by radiotherapy of women with breast cancer.

Topical Use of a Silymarin-Based Preparation to Prevent Radiodermatitis

“…Schlüsselwörter: Mammakarzinom · Strahlendermatitis · Silymarin · Leviaderm® · Panthenol bidity scoring criteria) [7,19,24]. Furthermore, the subjective toxicity was assessed using the Visual Analogue Scales (VAS) for itch, pain, and burning with a score of 0 defined as "no symptoms" and a score of 10 defined as "the worst severity ever experienced" [37].…”

“…Nevertheless, the most frequent complications of breast-conserving radiotherapy are radiodermatitis, breast edema, mastitis, and pneumonitis. It is estimated that 80-90% of patients with breast cancer develop radiodermatitis and approximately 10% of these patients show a grade 3 skin lesion before the scheduled end of RT [19,27]. Especially cutaneous side effects may both reduce the patient's compliance and quality of life.…”

Interactions between radiotherapy and endocrine therapy in breast cancer.

“…In addition, in our experience, the administration of chemotherapy and concomitant irradiation does not increase the intensity, or its frequency, of the acute adverse effects observed on the skin included in the treatment field (López et al 2002). However, it is generally accepted that some chemotherapy drugs, including taxanes, may enhance the effectiveness of radiation therapy although they may increase the incidence of radiation pneumonitis (Taghian et al 2001).…”

“…Among them, the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology group (RTOG) classification (Cox et al 1995) is a very comprehensive system that deals with both acute and late reactions. Our previous results (López et al 2002) point out the advantage of the RTOG system over others, at least for evaluating the acute effects produced by radiation treatment on the skin of women with breast cancer.…”

Treatment of radiation-induced mucocutaneous toxicity

“…It is estimated that more than 90% of patients undergoing curative irradiation with total doses >55 Gy will develop a radiodermatitis and approximately 10% of these patients encounter a grade 3 skin lesion before the scheduled end of RT [10]. Especially cutaneous side eff ects may both reduce the patient's compliance and quality of life.…”