Intensity Modulated Radiation Therapy (IMRT) Decreases Acute Skin Toxicity for Women Receiving Radiation for Breast Cancer

Freedman, Gary M.; Anderson, Penny R.; Li, Jinsheng; Eisenberg, D.; Hanlon, Alexandra L.; Wang, Lu; Nicolaou, Nicos

doi:10.1097/01.coc.0000197661.09628.03

Cited by 160 publications

(110 citation statements)

References 19 publications

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“…IMRT is also effective to increase dose homogeneity and reduce hot spots (11), but even with this technique a 20% to 40% rate of grade 3 acute side effects is observed in the supine position (12,13). The first results of the randomized trial were published in 2013 and showed a 2-to 3-fold reduction in acute skin toxicity with prone IMRT (4).…”

Section: Introductionmentioning

confidence: 99%

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Paelinck

Gulybán²,

Lakosi³

et al. 2017

Radiotherapy and Oncology

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SummaryThis is the first randomized trial reporting on the 2-year cosmetic outcome of prone and supine whole-breast irradiation in 94 patients with a cup size of at least C. Better cosmetic outcome was observed in prone-treated patients after 2 years with less skin color changes (PZ.05), less edema (PZ.06), and less worsening of cosmesis assessed by the Breast Cancer Conservation Treatment.cosmetic results software on digital photographs with both arms elevated.Purpose: To report the 2-year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted patients. Methods and Materials: One hundred patients with a (European) cup size C were included. Before and 2 years after radiation therapy, clinical endpoints were scored and digital photographs were taken with the arms alongside the body and with the arms elevated 180 . Three observers rated the photographs using the 4-point Harvard cosmesis scale. Cosmesis was also evaluated with the commercially available Breast Cancer Conservation Treatment.cosmetic results (BCCT.core) software. Results: Two-year follow-up data and photographs were available for 94 patients (47 supine treated and 47 prone treated). Patient and treatment characteristics were not significantly different between the 2 cohorts. Aworsening of color change occurred more frequently in the supine than in the prone cohort (19/46 vs 10/46 patients, respectively, PZ.04). Five patients in the prone group (11%) and 12 patients in the supine group (26%) presented with a worse scoring of edema at 2-year follow-up (PZ.06). For retraction and fibrosis, no significant differences were found between the 2 cohorts, although scores were generally worse in the supine cohort. The cosmetic scoring by 3 observers did not reveal differences between the prone and supine groups. On the photographs with the hands up, 7 patients in the supine group versus none in the prone group had a worsening of cosmesis of 2 categories using the BCCT.org software (PZ.02). Conclusion: With a limited follow-up of 2 years, better cosmetic outcome was observed in prone-treated than in supine-treated patients. Ó

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Section: Introductionmentioning

confidence: 99%

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Paelinck

Gulybán²,

Lakosi³

et al. 2017

Radiotherapy and Oncology

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“…Another study presented the results of a matched‐pair analysis of patients who had received either breast IMRT or standard RT 9. The study reported a significantly lower level of moist desquamation with IMRT than with standard RT using wedge compensation.…”

Section: Discussionmentioning

confidence: 99%

Compared with intensity‐modulated radiotherapy, image‐guided radiotherapy reduces severity of acute radiation‐induced skin toxicity during radiotherapy in patients with breast cancer

et al. 2018

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Radiotherapy (RT) is an effective treatment for breast cancer. The side effects of breast irradiation, including skin toxicity in the irradiation field, cause considerable discomfort. This study compared the severity of skin toxicity caused by image‐guided RT (IGRT) and intensity‐modulated RT (IMRT) combined with an electronic portal imaging device (EPID) in breast cancer. This study retrospectively analyzed 458 patients with breast cancer who had received RT. The patients were divided into two groups: 302 and 156 patients in the IMRT and IGRT groups. In the IGRT group, 8 and 148 patients had received helical tomotherapy irradiation and IMRT with cone‐beam computed tomography. Simple and multiple logistic regression analyses were used to estimate the relationship between RT technique and the severity of radiation skin toxicity. In our study, 284, 97, and 6 patients exhibited grades I, II, and III radiation dermatitis (RD). Moreover, 75 patients in the IMRT group (24.80%) and 22 patients in the IGRT group (14.10%) exhibited grade II RD. All patients with grade III RD were in the IMRT group (2.00%). No patient exhibited grade IV RD. The patients in the IGRT group exhibited less severity of RD than in the IMRT group. The severity of acute RD due to IGRT is significantly lower than that due to IMRT with EPID.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Objective: Adjuvant breast radiation increases the risk of acute dermatitis. We aimed to identify patient and treatment characteristics that may increase this risk to help individualize the prevention and management of radiation-induced skin toxicities. Methods/Materials:We analyzed 320 women with breast cancer who received adjuvant radiation for increased risk of acute dermatitis based upon age, BMI, histology, stage, chemotherapy, radiation fractionation, whole breast dose, tumor bed boost dose, total dose, diuretics use, smoking, diabetes, autoimmune disease, and chronic immunosuppression. Univariate logistic regression was used to compare each factor across the dermatitis groups. Significant factors were analyzed in a multivariate analysis.

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Intensity Modulated Radiation Therapy (IMRT) Decreases Acute Skin Toxicity for Women Receiving Radiation for Breast Cancer

Cited by 160 publications

References 19 publications

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Compared with intensity‐modulated radiotherapy, image‐guided radiotherapy reduces severity of acute radiation‐induced skin toxicity during radiotherapy in patients with breast cancer

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

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