Can cutaneous telangiectasiae as late normal-tissue injury predict cardiovascular disease in women receiving radiotherapy for breast cancer?

Abstract

Background: Overall, ∼5% of patients show late normal-tissue damage after radiotherapy with a smaller number having a risk of radiation-induced heart disease. Although the data are conflicting, large studies have shown increased risks of cardiovascular disease (CVD) for irradiated patients compared with non-irradiated ones, or for those treated to the left breast or chest wall compared with those treated to the right. Cutaneous telangiectasiae as late normal-tissue injury have so far only been regarded as a cosmetic burden. Methods: The relationship between late normal-tissue radiation injury phenotypes in 149 irradiated breast cancer patients and the presence of cardiovascular disease were examined. Results: A statistically significant association between the presence of skin telangiectasiae and the long-term risk of CVD was shown in these patients ( P =0.017; Fisher's exact test). Interpretation: This association may represent initial evidence that telangiectasiae can be used as a marker of future radiation-induced cardiac complications. It could also suggest a common biological pathway for the development of both telangiectasiae and CVD on the basis of a genetically predisposed endothelium. To our knowledge this is the first reported study looking at this association.

Factors modifying the risk for developing acute skin toxicity after whole-breast intensity modulated radiotherapy

“…During or shortly after the course of breast cancer RT, a large portion of the patients will experience acute radiation dermatitis to some degree, varying from mild to brisk erythema with or without moist desquamation and occasionally ulceration of the skin [ 2 ]. There is accumulating clinical evidence that acute reactions are associated with the development of late toxicity: Lilla et al showed that telangiectasia are in fact late sequelae of moist desquamation and acute erythema is shown to be a risk factor for poor cosmetic outcome [ 3 – 5 ]. Though the skin is not a dose-limiting tissue, skin toxicity is associated with impairment of patients’ quality of life, causes pain and discomfort and limits activities [ 2 , 6 ].…”

A new three-dimensional conformal radiotherapy (3DCRT) technique for large breast and/or high body mass index patients: evaluation of a novel fields assessment aimed to reduce extra–target-tissue irradiation

“…V 105% was chosen to specify the target volume receiving high doses. In addition, a conformity index (CI) was defined as CI 5 V ri / V PTV , where V ri is the volume encompassed by the reference isodose for the PTV (95% of the prescribed dose) and V PTV is the PTV volume expressed in cm 3 . Body-PTV healthy tissue V 10% , V 20% , V 105% and V 107% were defined as surrogates for extra-targettissue irradiation.…”

“…Patients were selected based on their anatomy (large or pendulous breasts, CT simulation breast volume .1000 cm 3 or when breast tissue tended to fall towards the mid axillary line, and/or a BMI of .25 kg m 22 ).…”

“…2 There is accumulating clinical evidence that acute reactions are associated with the development of late toxicity which includes telangiectasia, breast induration and pain. [3][4][5] The severity of RT-induced breast damage relates to the biological damage to the epidermis, dermis and connective tissue during treatment. 6 Although all patients undergoing RT are at risk of these reactions, there are a number of intrinsic and extrinsic risk factors that can affect the severity.…”

“…Methods: Two treatment plans [tangential fields and standardized five-fields technique (S5F)] for a total dose of 50 Gy/25 fractions were generated for patients with large breasts [planning target volume (PTV) .1000 cm 3 and/or BMI .25 kg m 22 ], supine positioned. S5F plans consist of two wedged tangential beams, anteroposterior: 20°for the right breast and 340°for the left breast, and posteroanterior: 181°for the right breast and 179°for the left breast.…”