Predictors of radiation-induced acute skin toxicity in breast cancer at a single institution: Role of fractionation and treatment volume

Abstract

PurposeThe associations among radiation fractionation, body mass index (BMI), and acute skin toxicity with adjuvant radiation for breast cancer is of increasing interest. This study evaluated the rate of grade ≥2 dermatitis and moist desquamation (MD) in patients with a high BMI who were treated to the breast or chest wall to understand the role of radiation target, fractionation regimen, and BMI.Methods and materialsWe retrospectively evaluated 280 patients treated with adjuvant radiation for breast cancer after up-front surgery. We collected information on patient demographics, disease and treatment characteristics, and acute skin toxicities. Multiple logistic regression models were used to evaluate for predictors of grade ≥2 dermatitis and MD.ResultsPatients undergoing post-mastectomy radiation therapy (PMRT) had the highest rate of MD (24%). The rate was lower (8.7%) among lumpectomy patients, but those receiving conventional fractionation had a higher rate of MD (10.9%) compared with hypofractionated therapy (1.8%; P = .05). Among lumpectomy patients, chemotherapy use (odds ratio, 3.74; P = .04) and regional nodal irradiation (odds ratio, 3.29; P = .03) were also significant predictors of MD. Despite an elevated average BMI among lumpectomy patients, hypofractionated therapy resulted in lower rates of skin toxicity.ConclusionsWe identified multiple risk factors for acute skin toxicity, including the use of PMRT and conventionally fractionated regimens. Elevated BMI, regional nodal irradiation, and chemotherapy use were associated with an increased risk of MD. Our findings highlight the need to explore the use of less toxic hypofractionated regimens in patients who are at the highest risk of acute skin toxicity, including those with a higher BMI and those receiving PMRT.

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

“…We had no grade 4 or 5 events. A recent retrospective analysis of breast cancer patients treated with radiation after surgery showed that acute skin toxicity was associated with elevated BMI and regional nodal irradiation . Likewise, we found that BMI > 30 kg/m 2 was associated with the development of severe toxicity.…”

“…A recent retrospective analysis of breast cancer patients treated with radiation after surgery showed that acute skin toxicity was associated with elevated BMI and regional nodal irradiation. 49 reRT, and 10% had concurrent chemotherapy with reRT. Inoperable localized disease can cause significant morbidity and have high rates of toxicities when treated with radiation and concurrent chemotherapy.…”

A comprehensive dosimetric study of Monte Carlo and pencil‐beam algorithms on intensity‐modulated proton therapy for breast cancer

“…The lower skin dose in the MCoptimized plans could then translate into a lower likelihood of severe radiation dermatitis. Previous studies by Liang et al 18 and by Parekh et al 19 showed that the risk of moist desquamation is much higher in post-mastectomy radiation therapy compared with breast conservation settings. Our current study also compared intact breast and CW groups.…”

Acute toxicities after proton beam therapy following breast‐conserving surgery for breast cancer: Multi‐institutional prospective PCG registry analysis

“…The only factor associated with grade 3 RD in our study was BMI (P = .02), which is consistent with other studies. 15,16 However, it is unclear if this is due to increased skin folds, larger amount of skin irradiated, or other factors. Furthermore, most patients in our study were treated with conventional fractionation.…”