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

Abstract

BackgroundAfter breast-conserving radiation therapy most patients experience acute skin toxicity to some degree. This may impair patients’ quality of life, cause pain and discomfort. In this study, we investigated treatment and patient-related factors, including genetic polymorphisms, that can modify the risk for severe radiation-induced skin toxicity in breast cancer patients.MethodsWe studied 377 patients treated at Ghent University Hospital and at ST.-Elisabeth Clinic and Maternity in Namur, with adjuvant intensity modulated radiotherapy (IMRT) after breast-conserving surgery for breast cancer. Women were treated in a prone or supine position with normofractionated (25 × 2 Gy) or hypofractionated (15 × 2.67 Gy) IMRT alone or in combination with other adjuvant therapies. Patient- and treatment-related factors and genetic markers in regulatory regions of radioresponsive genes and in LIG3, MLH1 and XRCC3 genes were considered as variables. Acute dermatitis was scored using the CTCAEv3.0 scoring system. Desquamation was scored separately on a 3-point scale (0-none, 1-dry, 2-moist).ResultsTwo-hundred and twenty patients (58%) developed G2+ dermatitis whereas moist desquamation occurred in 56 patients (15%). Normofractionation (both p < 0.001), high body mass index (BMI) (p = 0.003 and p < 0.001), bra cup size ≥ D (p = 0.001 and p = 0.043) and concurrent hormone therapy (p = 0.001 and p = 0.037) were significantly associated with occurrence of acute dermatitis and moist desquamation, respectively. Additional factors associated with an increased risk of acute dermatitis were the genetic variation in MLH1 rs1800734 (p=0.008), smoking during RT (p = 0.010) and supine IMRT (p = 0.004). Patients receiving trastuzumab showed decreased risk of acute dermatitis (p < 0.001).ConclusionsThe normofractionation schedule, supine IMRT, concomitant hormone treatment and patient related factors (high BMI, large breast, smoking during treatment and the genetic variation in MLH1 rs1800734) were associated with increased acute skin toxicity in patients receiving radiation therapy after breast-conserving surgery. Trastuzumab seemed to be protective.

Characterization of risk factors for adjuvant radiotherapy-associated pain in a tri-racial/ethnic breast cancer population

“…There were multiple studies evaluating the impact of adjuvant RT on pain but there have been inconsistent findings [2; 13; 15; 17; 21; 22; 26; 41]. Dose inhomogeneity measured by “hotspot” volume has emerged as an important risk factor for RT-associated pain or skin toxicity [10; 27]. However, many of these studies were either retrospective or cross-sectional, lacking temporal relationship and subject to recall bias.…”

Feasibility evaluation of prone breast irradiation with the Sagittilt© system including residual-intrafractional error assessment

“…Concerning large breast volumes, some efforts should be made to reduce the dose to the organs at risk [2][3][4] and to avoid hot spots within the target to prevent cardiac failure, secondary lung cancer, acute toxicity and impaired cosmetics [5][6][7]. To achieve these requirements various solutions exist, including the use of advanced radiotherapy techniques with or without deep inspiration breath-hold [8][9][10] or changing treatment position [5,11] or both [9,12,13].…”

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.…”